MEDICARE: SAMANTHA DOMINGUEZ OPPENHEIMER 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	104100000X	Social Worker	SC60493309	WA

General Provider Information

NPI Number	:	1265900815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DOMINGUEZ OPPENHEIMER MSW

Provider Business Mailing Address
First Line	:	515 3RD AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 S LANE ST STE 201
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2829
Country	:	US
Telephone Number	:	206-349-7224
Fax Number	:

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

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	11/12/2018

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