Provider Demographics
NPI:1659014298
Name:STAELENS, SAMANTHA MAY (MSW)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MAY
Last Name:STAELENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SPRING TER
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3017
Mailing Address - Country:US
Mailing Address - Phone:413-522-0321
Mailing Address - Fax:
Practice Address - Street 1:44 SPRING TER
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3017
Practice Address - Country:US
Practice Address - Phone:413-522-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2256711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty