Provider Demographics
NPI:1912712845
Name:NERI, SAMANTHA (EDS, LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:NERI
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 N CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2913
Mailing Address - Country:US
Mailing Address - Phone:847-372-0938
Mailing Address - Fax:
Practice Address - Street 1:5632 N CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2913
Practice Address - Country:US
Practice Address - Phone:847-372-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional