MEDICARE: MS. CHARMAINE SAMUDA LCSW

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	104100000X	Social Worker	7334	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558548057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARMAINE SAMUDA LCSW

Provider Business Mailing Address
First Line	:	30 HAZEL TER STE 10
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2240
Country	:	US
Telephone Number	:	203-553-9957
Fax Number	:	203-553-9957

Provider Business Practice Location Address
First Line	:	30 HAZEL TER STE 10
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2240
Country	:	US
Telephone Number	:	203-553-9957
Fax Number	:

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	02/21/2020

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