Basic Information
| Provider Information | |||||||||
| NPI: | 1902232010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEETZ | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MS.ED., M.PHIL.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 RUSSELL RD | ||||||||
| Address2: | |||||||||
| City: | PAOLI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193011236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106446464 | ||||||||
| FaxNumber: | 6109816078 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 WALNUT ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191024017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106446464 | ||||||||
| FaxNumber: | 6109816078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.