Provider Demographics
NPI:1679628358
Name:SAMEK, BARBARA J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:SAMEK
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 1:54 OLD COLONY AVE
Mailing Address - Street 2:P.O. BOX 356
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2014
Mailing Address - Country:US
Mailing Address - Phone:617-269-2933
Mailing Address - Fax:617-269-2965
Practice Address - Street 1:54 OLD COLONY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2014
Practice Address - Country:US
Practice Address - Phone:617-269-2933
Practice Address - Fax:617-269-2965
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1836101YA0400X
MA10276501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07302OtherBLUE CROSS BLUE SHIELD
MAP07302OtherBLUE CROSS BLUE SHIELD