Provider Demographics
NPI:1164714374
Name:ALZATE, SAMANTHA RAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:ALZATE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:RAE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:26 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1858
Mailing Address - Country:US
Mailing Address - Phone:860-944-4266
Mailing Address - Fax:
Practice Address - Street 1:16 BRACE RD STE 302
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1825
Practice Address - Country:US
Practice Address - Phone:860-944-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83901041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical