Provider Demographics
NPI:1336869064
Name:RENFREE, SAMANTHA (LAC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:RENFREE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-4105
Mailing Address - Country:US
Mailing Address - Phone:908-578-6808
Mailing Address - Fax:
Practice Address - Street 1:200 ATLANTIC AVE STE Q
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1352
Practice Address - Country:US
Practice Address - Phone:973-264-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00544200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health