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General NPI Number Information
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NPI Number | 1366123713
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Entity Type | Individual
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Provider Name | SAMANTHA SHEPPARD LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 300 PARKER ST
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City | MANCHESTER
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State | CT
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Zip | 06042-3632
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Country | US
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Telephone | 860-815-7634
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Fax |
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Provider Business Mailing Address
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Address Line | 46 TREMONT ST
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City | HARTFORD
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State | CT
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Zip | 06105-3069
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Country | US
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Telephone | 978-761-3400
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 19175307
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License Number State | CT
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