Provider Demographics
NPI:1912319963
Name:DICK, SAMANTHA MARIE (BS)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:DICK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:MARIE
Other - Last Name:CAPRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:88 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6354
Mailing Address - Country:US
Mailing Address - Phone:508-620-0010
Mailing Address - Fax:508-875-1439
Practice Address - Street 1:88 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6354
Practice Address - Country:US
Practice Address - Phone:508-620-0010
Practice Address - Fax:508-875-1439
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health