Healthcare Provider Details

I. General information

NPI: 1962799965
Provider Name (Legal Business Name): SAMANTHA DEIANA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MERRICK ST
WORCESTER MA
01609-1937
US

IV. Provider business mailing address

64 FERNBROOK RD
NORTHBOROUGH MA
01532-1863
US

V. Phone/Fax

Practice location:
  • Phone: 508-797-6100
  • Fax:
Mailing address:
  • Phone: 508-254-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: