Healthcare Provider Details

I. General information

NPI: 1669385191
Provider Name (Legal Business Name): SAMANTHA SHORROCK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 GREAT RD
ACTON MA
01720-5777
US

IV. Provider business mailing address

PO BOX 8
WHEELWRIGHT MA
01094-0008
US

V. Phone/Fax

Practice location:
  • Phone: 857-229-2852
  • Fax: 857-216-6588
Mailing address:
  • Phone: 508-422-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS42800215
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: