Provider Demographics
NPI:1861709123
Name:NORIEGA, SAMANTHA ROSE (MS)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ROSE
Last Name:NORIEGA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1514
Mailing Address - Country:US
Mailing Address - Phone:818-244-7257
Mailing Address - Fax:818-243-5431
Practice Address - Street 1:4760 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230
Practice Address - Country:US
Practice Address - Phone:310-390-6612
Practice Address - Fax:310-398-5690
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAIMF78770106H00000X
CALMFT110760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor