MEDICARE: SAMANTHA PRENTICE LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	33010348A	IN

General Provider Information

NPI Number	:	1386525269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA PRENTICE LSW

Provider Business Mailing Address
First Line	:	403 N MAIN ST
Second Line	:
City	:	HEBRON
State	:	IN
Zip	:	46341-8791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8718 WHITE OAK AVE
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-2738
Country	:	US
Telephone Number	:	219-838-5250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	09/09/2025

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Directions to “ SAMANTHA PRENTICE LSW” Practice Location

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