Provider Demographics
NPI:1912257866
Name:AMMANN, SAMANTHA SUZANNE (RN, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:SUZANNE
Last Name:AMMANN
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
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Mailing Address - Street 1:2740 56TH WAY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2562
Mailing Address - Country:US
Mailing Address - Phone:727-458-3668
Mailing Address - Fax:727-343-3493
Practice Address - Street 1:2331 BELLEAIR RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-1704
Practice Address - Country:US
Practice Address - Phone:727-458-3668
Practice Address - Fax:727-343-3493
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSW110021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical