Provider Demographics
NPI:1366935629
Name:ROBISON, SAMANTHA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 E 194TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1030
Mailing Address - Country:US
Mailing Address - Phone:440-226-0125
Mailing Address - Fax:
Practice Address - Street 1:12573 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2536
Practice Address - Country:US
Practice Address - Phone:440-201-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2024-09-08
Deactivation Date:2024-08-17
Deactivation Code:
Reactivation Date:2024-08-26
Provider Licenses
StateLicense IDTaxonomies
OH1-24-74833103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst