Provider Demographics
NPI:1699506394
Name:BERBRICK, SAMANTHA B
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:B
Last Name:BERBRICK
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 1:1523 FLOURNOY CIR W APT 10317
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-1436
Mailing Address - Country:US
Mailing Address - Phone:732-856-2074
Mailing Address - Fax:
Practice Address - Street 1:2759 STATE ROAD 580 STE AND213
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3352
Practice Address - Country:US
Practice Address - Phone:727-804-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health