Provider Demographics
NPI:1487491510
Name:MIDDLETON, SAMANTHA ARI (LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ARI
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6165 N RURAL ST APT 2333
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-0360
Mailing Address - Country:US
Mailing Address - Phone:765-210-8121
Mailing Address - Fax:
Practice Address - Street 1:6165 N RURAL ST APT 2333
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-0360
Practice Address - Country:US
Practice Address - Phone:765-210-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011197A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty