Provider Demographics
NPI:1518627389
Name:PAUNETTO-RIVERA, SAMUEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:PAUNETTO-RIVERA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W HARRY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-1455
Mailing Address - Country:US
Mailing Address - Phone:316-655-4441
Mailing Address - Fax:316-262-3968
Practice Address - Street 1:714 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3002
Practice Address - Country:US
Practice Address - Phone:316-295-4800
Practice Address - Fax:316-295-4811
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12174104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker