Provider Demographics
NPI:1720126832
Name:WAKACH, SAMANTHA WRIGHT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:WRIGHT
Last Name:WAKACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 1/2 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8413
Mailing Address - Country:US
Mailing Address - Phone:310-365-4295
Mailing Address - Fax:
Practice Address - Street 1:1949 1/2 WESTWOOD BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8414
Practice Address - Country:US
Practice Address - Phone:310-365-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical