Provider Demographics
NPI:1073870481
Name:MANEWITZ, SAMANTHA A (LICSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:A
Last Name:MANEWITZ
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1436
Mailing Address - Country:US
Mailing Address - Phone:617-775-5373
Mailing Address - Fax:617-552-5117
Practice Address - Street 1:288 WALNUT ST
Practice Address - Street 2:STE 220
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1948
Practice Address - Country:US
Practice Address - Phone:617-552-5116
Practice Address - Fax:617-552-5117
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006138A104100000X
IN34006979A1041C0700X
MA1182371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12647745OtherCAQH ID