Provider Demographics
NPI:1558495911
Name:FUSSELMAN, SAMANTHA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JEAN
Last Name:FUSSELMAN
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 1:560 J STREET
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814
Mailing Address - Country:US
Mailing Address - Phone:530-681-8284
Mailing Address - Fax:
Practice Address - Street 1:560 J ST
Practice Address - Street 2:SUITE 390
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2343
Practice Address - Country:US
Practice Address - Phone:530-681-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 187811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical