MEDICARE: MRS. SAMANTHA ANNE FRAGA 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	101YM0800X	Mental Health Counselor	SW6627	FL
2	1041C0700X	Clinical Social Worker	SW6627	FL

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

General Provider Information

NPI Number	:	1871712018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA ANNE FRAGA LCSW

Provider Business Mailing Address
First Line	:	1890 S MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-6404
Country	:	US
Telephone Number	:	561-966-9448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 S MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-6404
Country	:	US
Telephone Number	:	561-966-9448
Fax Number	:	561-966-9449

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	04/25/2023

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