Provider Demographics
NPI:1811333040
Name:KOST, SAMANTHA (MSW, LISW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KOST
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KAUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 E BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:246 NORTHLAND DR STE 200A
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3440
Practice Address - Country:US
Practice Address - Phone:330-725-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1502379-SUPV1041C0700X
OHS12013321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LE-00030583OtherLICENSE
I.1502379-SUPVOtherLICENSE
OH0172970Medicaid