Provider Demographics
NPI:1639991110
Name:TAYLOR, SAMANTHA (LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15027-1340
Mailing Address - Country:US
Mailing Address - Phone:412-559-7839
Mailing Address - Fax:
Practice Address - Street 1:1601 PORTER ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:PA
Practice Address - Zip Code:15027-1340
Practice Address - Country:US
Practice Address - Phone:412-559-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0252061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical