Provider Demographics
NPI:1558176040
Name:ESCUDERO, SAMANTHA R (BT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:ESCUDERO
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 S 117TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-6278
Mailing Address - Country:US
Mailing Address - Phone:520-236-8357
Mailing Address - Fax:
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2385
Practice Address - Country:US
Practice Address - Phone:520-231-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician