Provider Demographics
NPI:1427106970
Name:HEALY, SAM (LICSW)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:HEALY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CLIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2511
Mailing Address - Country:US
Mailing Address - Phone:781-665-4622
Mailing Address - Fax:
Practice Address - Street 1:76 CLIFFORD ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2511
Practice Address - Country:US
Practice Address - Phone:781-665-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10265431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical