Healthcare Provider Details

I. General information

NPI: 1073958898
Provider Name (Legal Business Name): SAMANTHA ELLEN REPPUCCI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA ELLEN BARTH

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WILLOW ST # B
SOUTH HAMILTON MA
01982-2255
US

IV. Provider business mailing address

111 HIGHLAND ST
SOUTH HAMILTON MA
01982-1704
US

V. Phone/Fax

Practice location:
  • Phone: 978-219-7121
  • Fax: 978-712-0237
Mailing address:
  • Phone: 978-810-8925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12906-MH-CC
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS20352427
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: