Provider Demographics
NPI:1740710037
Name:DICHIARA, SAMANTHA RAE
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:RAE
Last Name:DICHIARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 E NEWTON ST STE 802
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2841
Mailing Address - Country:US
Mailing Address - Phone:617-638-8013
Mailing Address - Fax:617-414-1975
Practice Address - Street 1:40 SPRING ST STE 215
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3474
Practice Address - Country:US
Practice Address - Phone:617-299-9956
Practice Address - Fax:844-238-9457
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program