Provider Demographics
NPI:1780283671
Name:ATTIANESE, SAMANTHA CAROL (MA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CAROL
Last Name:ATTIANESE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:CAROL
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1209 FLAT HEADS LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7027
Mailing Address - Country:US
Mailing Address - Phone:917-432-8929
Mailing Address - Fax:
Practice Address - Street 1:1209 FLAT HEADS LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7027
Practice Address - Country:US
Practice Address - Phone:917-432-8929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician