Provider Demographics
NPI:1982087649
Name:HANCOCK, SAMANTHA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 MOORLAND DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1128
Mailing Address - Country:US
Mailing Address - Phone:586-634-8983
Mailing Address - Fax:
Practice Address - Street 1:699 MOORLAND DR
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1128
Practice Address - Country:US
Practice Address - Phone:586-634-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI7401000810103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst