Provider Demographics
NPI:1053768002
Name:ALLEN, SAMANTHA QUINLAN STONE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:QUINLAN STONE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 COMMERCE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1644
Mailing Address - Country:US
Mailing Address - Phone:707-540-5873
Mailing Address - Fax:
Practice Address - Street 1:5880 COMMERCE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-1644
Practice Address - Country:US
Practice Address - Phone:707-540-5873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist