Provider Demographics
NPI:1740902907
Name:TANZOLA, SAMANTHA JOSEPHINE (MSW INTERN)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JOSEPHINE
Last Name:TANZOLA
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 GROVE ST UNIT 834
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5923
Mailing Address - Country:US
Mailing Address - Phone:551-225-1527
Mailing Address - Fax:
Practice Address - Street 1:344 GROVE ST UNIT 834
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5923
Practice Address - Country:US
Practice Address - Phone:201-589-0587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker