Provider Demographics
NPI:1558540278
Name:SAMPSON, CAROL H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:H
Last Name:SAMPSON
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 1:49 JOHN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1436
Mailing Address - Country:US
Mailing Address - Phone:203-307-3030
Mailing Address - Fax:103-255-7486
Practice Address - Street 1:49 JOHN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1436
Practice Address - Country:US
Practice Address - Phone:203-307-3030
Practice Address - Fax:103-255-7486
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical