Healthcare Provider Details

I. General information

NPI: 1629423397
Provider Name (Legal Business Name): SAMANTHA T CAMERINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 CHAMPA ST
DENVER CO
80205-2529
US

IV. Provider business mailing address

2111 CHAMPA ST
DENVER CO
80205-2529
US

V. Phone/Fax

Practice location:
  • Phone: 303-312-2217
  • Fax: 303-293-2309
Mailing address:
  • Phone: 303-312-2217
  • Fax: 303-293-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925307
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number72090984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: