Provider Demographics
NPI:1790669240
Name:ELMER, SAMANTA
Entity type:Individual
Prefix:
First Name:SAMANTA
Middle Name:
Last Name:ELMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WINNEBAGO RD
Mailing Address - Street 2:
Mailing Address - City:SEA RANCH LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2330
Mailing Address - Country:US
Mailing Address - Phone:954-654-8815
Mailing Address - Fax:
Practice Address - Street 1:13 E MELBOURNE AVE STE D
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5976
Practice Address - Country:US
Practice Address - Phone:321-677-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician