MEDICARE: MARLA SAMUEL MSW, 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	L6355	OR

General Provider Information

NPI Number	:	1831468370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA SAMUEL MSW, LCSW

Provider Business Mailing Address
First Line	:	575 FAITH AVE
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2508
Country	:	US
Telephone Number	:	541-227-6655
Fax Number	:	800-433-1396

Provider Business Practice Location Address
First Line	:	575 FAITH AVE
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2508
Country	:	US
Telephone Number	:	541-227-6655
Fax Number	:	800-433-1396

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

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	06/11/2026

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