Provider Demographics
NPI:1669674867
Name:O'CONNELL, SAMANTHA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:S
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:E
Other - Last Name:SAMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:32 PINE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2623
Mailing Address - Country:US
Mailing Address - Phone:401-368-8921
Mailing Address - Fax:
Practice Address - Street 1:500 VICTORY ROAD
Practice Address - Street 2:SOUTHSHORE MENTAL HEALTH/ BAYVIEW
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171
Practice Address - Country:US
Practice Address - Phone:617-847-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA685661OtherTUFTS
MA1312677Medicaid
MAM18708OtherBLUE CROSS
MAM20807Medicare ID - Type Unspecified