Provider Demographics
NPI:1215608500
Name:BRONSON, SAMAIYAH
Entity type:Individual
Prefix:MS
First Name:SAMAIYAH
Middle Name:
Last Name:BRONSON
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 1:130 ALFRED DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4426
Mailing Address - Country:US
Mailing Address - Phone:833-825-5246
Mailing Address - Fax:
Practice Address - Street 1:130 ALFRED DR STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4426
Practice Address - Country:US
Practice Address - Phone:833-825-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician