MEDICARE: SAMANTHA YEBOAH LCSW

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	010176	CT

General Provider Information

NPI Number	:	1336593672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA YEBOAH LCSW

Provider Business Mailing Address
First Line	:	15 FARM SPRINGS RD APT 232
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2591
Country	:	US
Telephone Number	:	203-767-8840
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 N MAIN ST STE 100
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-1957
Country	:	US
Telephone Number	:	203-767-8840
Fax Number	:

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

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/17/2026

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