Provider Demographics
NPI:1538817853
Name:SILLETT, SAMANTHA E (BSL)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:SILLETT
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 BACK ST APT B
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1048
Mailing Address - Country:US
Mailing Address - Phone:724-640-9672
Mailing Address - Fax:
Practice Address - Street 1:322 BACK ST APT B
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1048
Practice Address - Country:US
Practice Address - Phone:724-640-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003308103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst