MEDICARE: SAMANTHA KASSANDRA DEVEAU 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	101YP2500X	Professional Counselor	LICSW126318	MA

General Provider Information

NPI Number	:	1962032144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA KASSANDRA DEVEAU LCSW

Provider Business Mailing Address
First Line	:	5110 WASHINGTON ST APT 6
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-5212
Country	:	US
Telephone Number	:	347-833-6554
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 WASHINGTON ST APT 6
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-5212
Country	:	US
Telephone Number	:	857-313-3343
Fax Number	:

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

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	11/13/2024

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