Provider Demographics
NPI:1780364141
Name:MINER, SAMANTHA (LSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MINER
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 STATE ROUTE 45 N
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9352
Mailing Address - Country:US
Mailing Address - Phone:440-563-3400
Mailing Address - Fax:440-563-9619
Practice Address - Street 1:2863 STATE ROUTE 45 N
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9352
Practice Address - Country:US
Practice Address - Phone:440-564-3400
Practice Address - Fax:440-563-9619
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
OHS.2411192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management