Provider Demographics
NPI:1801676440
Name:IRIZARRY, SAMANTHA LEIGH (MSW, LSW)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 SEVEN BRIDGE RD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7608
Mailing Address - Country:US
Mailing Address - Phone:570-730-1234
Mailing Address - Fax:
Practice Address - Street 1:529 SEVEN BRIDGE RD UNIT 201
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7608
Practice Address - Country:US
Practice Address - Phone:570-730-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06768300104100000X
PASW138877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker