Healthcare Provider Details

I. General information

NPI: 1043834575
Provider Name (Legal Business Name): SAMANTHA L BRUMETT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W HIGH ST STE 350
LIMA OH
45801-2915
US

IV. Provider business mailing address

750 W HIGH ST STE 350
LIMA OH
45801-2915
US

V. Phone/Fax

Practice location:
  • Phone: 937-831-4406
  • Fax:
Mailing address:
  • Phone: 937-831-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2304859-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS1903854
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: