MEDICARE: MS. SAMANTHA JEAN FUSSELMAN 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	LCS 18781	CA

General Provider Information

NPI Number	:	1558495911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA JEAN FUSSELMAN LCSW

Provider Business Mailing Address
First Line	:	560 J STREET
Second Line	:	SUITE 390
City	:	SACRAMENTO
State	:	CA
Zip	:	95814
Country	:	US
Telephone Number	:	530-681-8284
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 J ST
Second Line	:	SUITE 390
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-2343
Country	:	US
Telephone Number	:	530-681-8284
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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