MEDICARE: MS. ROBERTA LEE SAMET LCSW CLINICAL SOCIAL

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	1041C0700X	Clinical Social Worker	R01855201	NY

General Provider Information

NPI Number	:	1295575827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBERTA LEE SAMET LCSW CLINICAL SOCIAL

Provider Business Mailing Address
First Line	:	483 4TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3006
Country	:	US
Telephone Number	:	718-344-0081
Fax Number	:

Provider Business Practice Location Address
First Line	:	483 4TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3006
Country	:	US
Telephone Number	:	718-344-0081
Fax Number	:

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

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	05/30/2024

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