Healthcare Provider Details

I. General information

NPI: 1124452529
Provider Name (Legal Business Name): SAMANTHA MAIORI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2301 OLD FT WEAVER RD
EWA BEACH HI
96706-3602
US

IV. Provider business mailing address

C/O BRIDGEPORT HOSPITAL REACH PROGRAM 1558 BARNUM AVE.
BRIDGEPORT CT
06610-3238
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-8511
  • Fax: 808-677-2570
Mailing address:
  • Phone: 203-384-3653
  • Fax: 203-378-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW-2054
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number010141
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4134
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: