Healthcare Provider Details

I. General information

NPI: 1376610006
Provider Name (Legal Business Name): SAMANTHA CADY WRIGHT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13683 STANFORD DRIVE
CARMEL IN
46074-8448
US

IV. Provider business mailing address

1807 SMITH ST
LOGANSPORT IN
46947-1576
US

V. Phone/Fax

Practice location:
  • Phone: 317-590-6512
  • Fax: 949-561-5820
Mailing address:
  • Phone: 574-732-1414
  • Fax: 574-732-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16292
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006107A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: