Provider Demographics
NPI:1619759917
Name:SAMEDI, SARA BLYTHE (LCSW-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:BLYTHE
Last Name:SAMEDI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BLYTHE
Other - Last Name:EVJEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 467 BOX 1296
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096-1013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTAUL REGIONAL MEDICAL CENTER
Practice Address - Street 2:CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:314-590-8326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD282311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical