Provider Demographics
NPI:1306103445
Name:CLARKE, SAMANTHA K (LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34 WELCH AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2935
Mailing Address - Country:US
Mailing Address - Phone:860-741-3001
Mailing Address - Fax:860-741-8332
Practice Address - Street 1:113 ELM ST STE 204
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3739
Practice Address - Country:US
Practice Address - Phone:860-741-3001
Practice Address - Fax:086-741-8332
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002170101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA412956OtherOXFORD
CT4553929OtherAETNA
CT201366OtherMNH
CT004121141Medicaid
CT321137/A324839OtherVALUE OPTIONS