MEDICARE: MS. SAMANTHA MAZZAN QMHP; MSW SUPERVISEE

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		VA

General Provider Information

NPI Number	:	1487589016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA MAZZAN QMHP; MSW SUPERVISEE

Provider Business Mailing Address
First Line	:	19084 YOUNGS CLIFF RD
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-2568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6563 EDSALL RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-4414
Country	:	US
Telephone Number	:	703-354-0000
Fax Number	:	703-354-1129

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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