Provider Demographics
NPI:1518310978
Name:EMBERLEY, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:EMBERLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 WORCESTER ST
Mailing Address - Street 2:KENNEDY DONOVAN CENTER
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-1386
Mailing Address - Country:US
Mailing Address - Phone:508-765-0292
Mailing Address - Fax:508-765-0294
Practice Address - Street 1:486 WORCESTER ST
Practice Address - Street 2:KENNEDY DONOVAN CENTER
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1386
Practice Address - Country:US
Practice Address - Phone:508-765-0292
Practice Address - Fax:508-765-0294
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist