Provider Demographics
NPI:1386453454
Name:TODD, SAMANTHA (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 WOODRUFF PLACE EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1917
Mailing Address - Country:US
Mailing Address - Phone:260-228-1136
Mailing Address - Fax:
Practice Address - Street 1:549 WOODRUFF PLACE EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-1917
Practice Address - Country:US
Practice Address - Phone:260-228-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011622A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical