Provider Demographics
NPI:1801513213
Name:RIDEN, SAMANTHA (LCMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:RIDEN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:TUEPKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9229
Mailing Address - Country:US
Mailing Address - Phone:802-345-5343
Mailing Address - Fax:
Practice Address - Street 1:277 BLAIR PARK RD STE 210
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7885
Practice Address - Country:US
Practice Address - Phone:802-345-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health