Provider Demographics
NPI:1336553056
Name:VANSCOY, SAMANTHA (MA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:VANSCOY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 FOOTHILLD BLVD
Mailing Address - Street 2:SUITE 103-123
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1631
Mailing Address - Country:US
Mailing Address - Phone:909-295-2086
Mailing Address - Fax:
Practice Address - Street 1:744 N ECKHOFF STREET
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-940-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic