Provider Demographics
NPI:1770176240
Name:BLANCO, SAMANTHA LORAINE (MSW, BSW, LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LORAINE
Last Name:BLANCO
Suffix:
Gender:F
Credentials:MSW, BSW, LCSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LORAINE
Other - Last Name:BAPTISTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, BSW, LCSW
Mailing Address - Street 1:10 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1808
Mailing Address - Country:US
Mailing Address - Phone:910-580-0594
Mailing Address - Fax:
Practice Address - Street 1:220 SWINBURNE ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1834
Practice Address - Country:US
Practice Address - Phone:919-212-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143621041C0700X
NCC0148511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical