Provider Demographics
NPI:1255963765
Name:MENARD, SAMANTHA R (BA,LCDP, CADC, ICADC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:R
Last Name:MENARD
Suffix:
Gender:F
Credentials:BA,LCDP, CADC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3363
Mailing Address - Country:US
Mailing Address - Phone:401-773-7116
Mailing Address - Fax:
Practice Address - Street 1:1023 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3363
Practice Address - Country:US
Practice Address - Phone:401-773-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00754101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty