Provider Demographics
NPI:1881181600
Name:ALLEN, SAMANTHA P (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:P
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:P
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:4911 FIELDING WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2511
Mailing Address - Country:US
Mailing Address - Phone:502-744-9284
Mailing Address - Fax:
Practice Address - Street 1:955 N WILSON RD STE G
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1487
Practice Address - Country:US
Practice Address - Phone:502-314-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8709106E00000X
KY265059103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst