Provider Demographics
NPI:1821831611
Name:LINDLEY, SAMANTHA SUE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUE
Last Name:LINDLEY
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 1:1450 16TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2118
Mailing Address - Country:US
Mailing Address - Phone:813-326-0466
Mailing Address - Fax:
Practice Address - Street 1:7320 GRIFFIN RD STE 223
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4105
Practice Address - Country:US
Practice Address - Phone:954-405-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist