Healthcare Provider Details

I. General information

NPI: 1922756105
Provider Name (Legal Business Name): SAMANTHA JENAE PERRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA MAZE

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S HAMILTON ST
CHANDLER AZ
85225-6308
US

IV. Provider business mailing address

8088 W WHITNEY DR
PEORIA AZ
85345-6564
US

V. Phone/Fax

Practice location:
  • Phone: 833-855-9973
  • Fax: 602-655-9610
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-20827
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-17438
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: