Provider Demographics
NPI:1770062044
Name:GAYDOSH, SAMANTHA LIN (LLMSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LIN
Last Name:GAYDOSH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 W WILLOW HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1418
Mailing Address - Country:US
Mailing Address - Phone:517-442-6405
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD # 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0426
Practice Address - Country:US
Practice Address - Phone:517-442-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker