MEDICARE: SAMANTHA DESALVO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHC00438-A	RI

General Provider Information

NPI Number	:	1285460923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DESALVO

Provider Business Mailing Address
First Line	:	145 BENNETT ST
Second Line	:
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-4618
Country	:	US
Telephone Number	:	401-651-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 PONTIAC AVE # 100
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-1248
Country	:	US
Telephone Number	:	401-895-9937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2024
Last Update Date	:	01/14/2026

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Directions to “ SAMANTHA DESALVO ” Practice Location

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