Provider Demographics
NPI:1316634223
Name:VERUTTI, SAMUEL PATRICK (LCSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PATRICK
Last Name:VERUTTI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2180
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-2180
Mailing Address - Country:US
Mailing Address - Phone:209-247-7626
Mailing Address - Fax:
Practice Address - Street 1:255 SQUAW VALLEY RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161
Practice Address - Country:US
Practice Address - Phone:530-583-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12525517-35011041C0700X
COCSW.099291711041C0700X
CALCSW1236231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical