Provider Demographics
NPI:1306418918
Name:SHROBA, SAMANTHA JOY (BCBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOY
Last Name:SHROBA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LEON RIVER LOOP
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2002
Mailing Address - Country:US
Mailing Address - Phone:815-993-0665
Mailing Address - Fax:
Practice Address - Street 1:1625 WILLIAMS DR BLDG D
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3612
Practice Address - Country:US
Practice Address - Phone:815-993-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7128103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst