Provider Demographics
NPI:1235552514
Name:SAMPSON, SHALITA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHALITA
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BROOK HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2001
Mailing Address - Country:US
Mailing Address - Phone:203-623-9786
Mailing Address - Fax:203-745-4215
Practice Address - Street 1:75 BROOK HILL RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2001
Practice Address - Country:US
Practice Address - Phone:203-623-9786
Practice Address - Fax:203-745-4215
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical