Provider Demographics
NPI:1730075029
Name:MARQUES, SAMANTHA (LICSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MARQUES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WEST ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2677
Mailing Address - Country:US
Mailing Address - Phone:774-260-6437
Mailing Address - Fax:
Practice Address - Street 1:22 WEST ST STE 4A
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2677
Practice Address - Country:US
Practice Address - Phone:774-260-6437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2233381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical