MEDICARE: MS. SAMANTHA BRAY 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	54539	TX

General Provider Information

NPI Number	:	1871931428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA BRAY LCSW

Provider Business Mailing Address
First Line	:	3355 BEE CAVES RD STE 508
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6682
Country	:	US
Telephone Number	:	512-636-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 BEE CAVES RD STE 508
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6682
Country	:	US
Telephone Number	:	512-636-0104
Fax Number	:

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

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	07/21/2022

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