Individual
SAMANTHA BLACKADAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LICSW
Contact information
Practice address
100 GANNETT DR, SOUTH PORTLAND, ME 04106-5900
(207) 854-1030
Mailing address
46 EVANS ROAD, BRIDGTON, ME 04009
(603) 969-5317
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC18385
—
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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