Provider Demographics
NPI:1457122335
Name:LEUSCHNER, SAMANTHA (LICSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LEUSCHNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:LEUSCHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASHMANKAS LICSW
Mailing Address - Street 1:5 OPTICAL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-2559
Mailing Address - Country:US
Mailing Address - Phone:508-519-3507
Mailing Address - Fax:
Practice Address - Street 1:5 OPTICAL DR
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2559
Practice Address - Country:US
Practice Address - Phone:508-519-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126243104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker