MEDICARE: SANDRA SAMAME 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	SW8384	FL

General Provider Information

NPI Number	:	1437534658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SAMAME LCSW

Provider Business Mailing Address
First Line	:	3419 COCOPLUM CIR
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33063-5924
Country	:	US
Telephone Number	:	561-635-6059
Fax Number	:

Provider Business Practice Location Address
First Line	:	3419 COCOPLUM CIR
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33063-5924
Country	:	US
Telephone Number	:	561-635-6059
Fax Number	:

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

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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