Provider Demographics
NPI:1871512939
Name:SAMORA, FRANCIS G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:G
Last Name:SAMORA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:F
Other - Middle Name:GEOFFREY
Other - Last Name:SAMORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:150 W ANGELA BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1101
Mailing Address - Country:US
Mailing Address - Phone:574-232-5065
Mailing Address - Fax:574-232-5386
Practice Address - Street 1:150 W ANGELA BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1101
Practice Address - Country:US
Practice Address - Phone:574-232-5065
Practice Address - Fax:574-232-5386
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002397A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34002397AOtherSTATE OF INDIANA LICENSE
IN168900Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER