Provider Demographics
NPI:1245836394
Name:CRONIN, SAMANTHA (LMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CRONIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 MAIN ST UNIT 714-C
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2000
Mailing Address - Country:US
Mailing Address - Phone:617-869-3740
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:714 MAIN ST UNIT 714-C
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2000
Practice Address - Country:US
Practice Address - Phone:617-869-3740
Practice Address - Fax:508-433-1871
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health