Provider Demographics
NPI:1659952604
Name:PENEDOS, SAMANTHA LAUREN (LPC, ATR)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:LAUREN
Last Name:PENEDOS
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LAUREN
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-2552
Mailing Address - Country:US
Mailing Address - Phone:610-823-3185
Mailing Address - Fax:
Practice Address - Street 1:177 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-2552
Practice Address - Country:US
Practice Address - Phone:610-823-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional