Healthcare Provider Details

I. General information

NPI: 1538944798
Provider Name (Legal Business Name): SAMANTHA SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 NORTH MAIN STREET BRONSON BLDG, 5TH FLOOR
ATTLEBORO MA
02703-2282
US

IV. Provider business mailing address

8 NORTH MAIN ST BRONSON BLDG, 5TH FLOOR
ATTLEBORO MA
02703
US

V. Phone/Fax

Practice location:
  • Phone: 508-409-0000
  • Fax:
Mailing address:
  • Phone: 508-409-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW03270
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: