Healthcare Provider Details

I. General information

NPI: 1104315001
Provider Name (Legal Business Name): SAMANTHA ALDRIDGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SILAS DEANE HWY 3RD FLOOR
WETHERSFIELD CT
06109
US

IV. Provider business mailing address

185 SILAS DEANE HWY 3RD FLOOR
WETHERSFIELD CT
06109
US

V. Phone/Fax

Practice location:
  • Phone: 860-944-5497
  • Fax:
Mailing address:
  • Phone: 860-944-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13136
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: