MEDICARE: GABRIELLE LILLIAN SAMANIEGO ASW

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	123015	CA

General Provider Information

NPI Number	:	1518640861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE LILLIAN SAMANIEGO ASW

Provider Business Mailing Address
First Line	:	PO BOX 1006
Second Line	:
City	:	BLUE LAKE
State	:	CA
Zip	:	95525-1006
Country	:	US
Telephone Number	:	707-845-8737
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 1006
Second Line	:
City	:	BLUE LAKE
State	:	CA
Zip	:	95525-1006
Country	:	US
Telephone Number	:	707-845-8737
Fax Number	:

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

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	07/08/2024

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