Provider Demographics
NPI:1962220038
Name:FRUM, SAMANTHA (LMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:FRUM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11170 SW HADLEY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2853
Mailing Address - Country:US
Mailing Address - Phone:516-673-5816
Mailing Address - Fax:
Practice Address - Street 1:11170 SW HADLEY ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2853
Practice Address - Country:US
Practice Address - Phone:516-673-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health