Provider Demographics
NPI:1841883469
Name:SAMANTHA V WATSON
Entity type:Organization
Organization Name:SAMANTHA V WATSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICSW/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-290-6000
Mailing Address - Street 1:24 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5237
Mailing Address - Country:US
Mailing Address - Phone:978-290-6000
Mailing Address - Fax:
Practice Address - Street 1:131 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2048
Practice Address - Country:US
Practice Address - Phone:617-286-4505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty