Healthcare Provider Details

I. General information

NPI: 1417876392
Provider Name (Legal Business Name): SAMANTHA AUDREY ACKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAM ACKER LCSW

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANCIS ST
BOSTON MA
02115-6105
US

IV. Provider business mailing address

63 BRENTWOOD ST
BOSTON MA
02134-1302
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-6351
  • Fax:
Mailing address:
  • Phone: 650-353-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2141209
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: