1417041161 NPI number — MS. SAMANTHA J. LITTLEFIELD LISW

Table of content: MS. SAMANTHA J. LITTLEFIELD LISW (NPI 1417041161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417041161 NPI number — MS. SAMANTHA J. LITTLEFIELD LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTLEFIELD
Provider First Name:
SAMANTHA
Provider Middle Name:
J.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417041161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1603
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRACRES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88033-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-621-2687
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N CHURCH ST STE 200B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-3515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-642-8046
Provider Business Practice Location Address Fax Number:
575-526-9819
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  M-05229 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: I-06817 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03146112003 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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