Provider Demographics
NPI:1255659652
Name:SAMSON, MOLLY (MED)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SEAPOINT RD
Mailing Address - Street 2:
Mailing Address - City:KITTERY POINT
Mailing Address - State:ME
Mailing Address - Zip Code:03905-5212
Mailing Address - Country:US
Mailing Address - Phone:603-661-5323
Mailing Address - Fax:
Practice Address - Street 1:47 SEAPOINT RD
Practice Address - Street 2:
Practice Address - City:KITTERY POINT
Practice Address - State:ME
Practice Address - Zip Code:03905-5212
Practice Address - Country:US
Practice Address - Phone:603-661-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH#0100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003400Medicaid