MEDICARE: MS. SAMARA MARIE LOUISSAINT MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1104084011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMARA MARIE LOUISSAINT MSW

Provider Business Mailing Address
First Line	:	964 SAGE AVE
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8272
Country	:	US
Telephone Number	:	561-753-2937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1339 FORUM PLACE
Second Line	:	SUITE 7
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401
Country	:	US
Telephone Number	:	561-712-8821
Fax Number	:	561-712-8070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	05/28/2008

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