Provider Demographics
NPI:1912320854
Name:PETROSKI, SAMANTHA JOANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JOANNE
Last Name:PETROSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SMANTHA
Other - Middle Name:JOANNE
Other - Last Name:SCODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:8220 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2729
Mailing Address - Country:US
Mailing Address - Phone:215-728-4600
Mailing Address - Fax:215-745-6511
Practice Address - Street 1:8220 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-2729
Practice Address - Country:US
Practice Address - Phone:215-728-4600
Practice Address - Fax:215-745-6511
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health