Provider Demographics
NPI:1699594762
Name:POOLSON, SAMANTHA (RBT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:POOLSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3702
Mailing Address - Country:US
Mailing Address - Phone:727-418-8654
Mailing Address - Fax:
Practice Address - Street 1:1101 BELCHER RD S STE B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3356
Practice Address - Country:US
Practice Address - Phone:727-742-7872
Practice Address - Fax:877-271-9338
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-382629106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician