Provider Demographics
NPI:1326435298
Name:BRACEY, SAMANTHA RAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:BRACEY
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 1:396 S CENTRE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3597
Mailing Address - Country:US
Mailing Address - Phone:570-573-3604
Mailing Address - Fax:
Practice Address - Street 1:396 S CENTRE ST STE 3
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3597
Practice Address - Country:US
Practice Address - Phone:570-573-3604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0207251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical