MEDICARE: SAMANTHA BROO

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	101YP2500X	Professional Counselor	37AC00719500	NJ

General Provider Information

NPI Number	:	1679264469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BROO

Provider Business Mailing Address
First Line	:	42 DELSEA DR S
Second Line	:
City	:	GLASSBORO
State	:	NJ
Zip	:	08028-2621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6821 BLACK HORSE PIKE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-4101
Country	:	US
Telephone Number	:	844-722-3632
Fax Number	:

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

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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Directions to “ SAMANTHA BROO ” Practice Location

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