1235476201 NPI number — MRS. SAMANTHA C TURNER LPC

Table of content: MRS. SAMANTHA C TURNER LPC (NPI 1235476201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235476201 NPI number — MRS. SAMANTHA C TURNER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNER
Provider First Name:
SAMANTHA
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEST
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235476201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 CARIATI BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06451-3683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-654-5812
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 WATERTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMASTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06787-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-819-0789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2013

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: 101YP2500X , with the licence number:  2582 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008054442 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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