Provider Demographics
NPI:1821738154
Name:MARTIN, SAMANTHA K (101YM0800X)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:101YM0800X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ROBERT DR UNIT A9
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1369
Mailing Address - Country:US
Mailing Address - Phone:781-733-6174
Mailing Address - Fax:
Practice Address - Street 1:450 PEARL ST STE 3
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1617
Practice Address - Country:US
Practice Address - Phone:781-733-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health