Healthcare Provider Details

I. General information

NPI: 1164336384
Provider Name (Legal Business Name): SAMANTHA VAN ETTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MOUNTAIN CT
HACKETTSTOWN NJ
07840-2317
US

IV. Provider business mailing address

20 NORTH RD
CHESTER NJ
07930-2308
US

V. Phone/Fax

Practice location:
  • Phone: 201-727-3241
  • Fax:
Mailing address:
  • Phone: 201-306-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07162400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: