Healthcare Provider Details

I. General information

NPI: 1972419745
Provider Name (Legal Business Name): SAMARA BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SUITE 3, EAST MARKET STREET
WARREN OH
44484-2340
US

IV. Provider business mailing address

8700 SUITE 3, EAST MARKET STREET
WARREN OH
44484-2340
US

V. Phone/Fax

Practice location:
  • Phone: 330-506-5635
  • Fax: 330-237-7978
Mailing address:
  • Phone: 330-506-5635
  • Fax: 330-237-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: