Provider Demographics
NPI:1073958898
Name:REPPUCCI, SAMANTHA ELLEN (LMHC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELLEN
Last Name:REPPUCCI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ELLEN
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1704
Mailing Address - Country:US
Mailing Address - Phone:978-810-8925
Mailing Address - Fax:
Practice Address - Street 1:205 WILLOW ST # B
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2255
Practice Address - Country:US
Practice Address - Phone:978-219-7121
Practice Address - Fax:978-712-0237
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS20352427390200000X
MA12906-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program