Provider Demographics
NPI:1649079922
Name:DIEHL, SAMANTHA (BCBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DIEHL
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:VT
Mailing Address - Zip Code:05701-6505
Mailing Address - Country:US
Mailing Address - Phone:518-937-3793
Mailing Address - Fax:
Practice Address - Street 1:PO BOX G
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-0167
Practice Address - Country:US
Practice Address - Phone:802-728-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT146.0134353103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst