Healthcare Provider Details

I. General information

NPI: 1376278192
Provider Name (Legal Business Name): SAMANTHA DRACUP LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WASHINGTON AVE
HALETHORPE MD
21227-3115
US

IV. Provider business mailing address

2700 WASHINGTON AVE
HALETHORPE MD
21227-3115
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-2353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25240
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: