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General NPI Number Information
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NPI Number | 1316634223
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Entity Type | Individual
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Provider Name | SAMUEL PATRICK VERUTTI LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/20/2023
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 255 SQUAW VALLEY RD
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City | TRUCKEE
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State | CA
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Zip | 96161
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Country | US
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Telephone | 530-583-8665
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2180
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City | TRUCKEE
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State | CA
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Zip | 96160-2180
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Country | US
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Telephone | 209-247-7626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12525517-3501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09929171
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW123623
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License Number State | CA
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