Provider Demographics
NPI:1841855434
Name:RUDMAN, SAMANTHA NICOLE (LCPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:RUDMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LGPC
Mailing Address - Street 1:6508 DEER POINTE DR STE 4C
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1668
Mailing Address - Country:US
Mailing Address - Phone:410-742-6016
Mailing Address - Fax:410-742-6014
Practice Address - Street 1:6508 DEER POINTE DR STE 4
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1668
Practice Address - Country:US
Practice Address - Phone:410-742-6016
Practice Address - Fax:410-742-6014
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
MDLC15999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483106300Medicaid