Provider Demographics
NPI:1710691183
Name:HUTCHINSON, SAMANTHA (BCABA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 CLYDESDALE CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-6898
Mailing Address - Country:US
Mailing Address - Phone:407-902-4212
Mailing Address - Fax:
Practice Address - Street 1:11602 LAKE UNDERHILL RD STE 129
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4460
Practice Address - Country:US
Practice Address - Phone:407-277-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-253092106S00000X
0-25-16266106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician