MEDICARE: SAMANTHA MANDALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06593000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902412372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MANDALA

Provider Business Mailing Address
First Line	:	2340 ROUTE 9
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-4016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 ROUTE 9
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-4016
Country	:	US
Telephone Number	:	732-987-9770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	01/15/2026

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Directions to “ SAMANTHA MANDALA ” Practice Location

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