Healthcare Provider Details

I. General information

NPI: 1265318620
Provider Name (Legal Business Name): SAMANTHA NICOLE TORRES MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA NICOLE PAXTON MSW, ACSW

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9689 WISTERIA CT
BLOOMINGTON CA
92316
US

IV. Provider business mailing address

1382 BLUE OAKS BLVD STE 213
ROSEVILLE CA
95678-7052
US

V. Phone/Fax

Practice location:
  • Phone: 909-503-3289
  • Fax:
Mailing address:
  • Phone: 877-412-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW127238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: