Provider Demographics
NPI:1528547924
Name:SHAUGHNESSY, SAMANTHA L (LICSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 EAST ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1109
Mailing Address - Country:US
Mailing Address - Phone:617-913-6364
Mailing Address - Fax:
Practice Address - Street 1:619 EAST ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1109
Practice Address - Country:US
Practice Address - Phone:617-790-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1181721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical