Provider Demographics
NPI:1427510031
Name:MENENDEZ, SAMANTHA RENEE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RENEE
Last Name:MENENDEZ
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 1:4228 SW DAWSON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1245
Mailing Address - Country:US
Mailing Address - Phone:509-846-3509
Mailing Address - Fax:
Practice Address - Street 1:4228 SW DAWSON ST APT 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1245
Practice Address - Country:US
Practice Address - Phone:509-846-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61526719103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst