Healthcare Provider Details

I. General information

NPI: 1689172017
Provider Name (Legal Business Name): SAMANTHA UEBERROTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 PATIENT CARE DR STE 104
LANSING MI
48911-4276
US

IV. Provider business mailing address

3960 PATIENT CARE DR STE 104
LANSING MI
48911-4276
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-9801
  • Fax: 517-887-9826
Mailing address:
  • Phone: 517-887-9801
  • Fax: 517-887-9826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801102159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: