Provider Demographics
NPI:1851996193
Name:RICCI, SAMANTHA DANIELLE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:DANIELLE
Last Name:RICCI
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 1:7 DRAPER WOODS RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1180
Mailing Address - Country:US
Mailing Address - Phone:413-221-0783
Mailing Address - Fax:
Practice Address - Street 1:7 DRAPER WOODS RD
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01518-1180
Practice Address - Country:US
Practice Address - Phone:413-221-0783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 390200000X
MA000227181041C0700X
MA1281431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA128143OtherASWB