Provider Demographics
NPI:1790867240
Name:SAMSON, MAUREEN SHANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:SHANA
Last Name:SAMSON
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 1:619 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2407
Mailing Address - Country:US
Mailing Address - Phone:415-420-5097
Mailing Address - Fax:415-386-2838
Practice Address - Street 1:619 47TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2407
Practice Address - Country:US
Practice Address - Phone:415-420-5097
Practice Address - Fax:415-386-2838
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS186361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS186360Medicare UPIN
CAZZZ27524ZMedicare ID - Type UnspecifiedSOCIAL WORKER