Provider Demographics
NPI:1063956621
Name:RIDOUT, SAMANTHA RENE (BCBA, LBA-NYS)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:RENE
Last Name:RIDOUT
Suffix:
Gender:
Credentials:BCBA, LBA-NYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LIMEKILN PIKE STE B19
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1503
Mailing Address - Country:US
Mailing Address - Phone:917-203-3737
Mailing Address - Fax:
Practice Address - Street 1:1650 LIMEKILN PIKE STE B19
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1503
Practice Address - Country:US
Practice Address - Phone:917-203-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-22-57709103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst