Healthcare Provider Details

I. General information

NPI: 1326829466
Provider Name (Legal Business Name): MARIAH SAMUELS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MAIN ST
NEW BRITAIN CT
06051-4204
US

IV. Provider business mailing address

51 HOLLY CT
BERLIN CT
06037-3635
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-8192
  • Fax:
Mailing address:
  • Phone: 860-770-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15820
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: