Provider Demographics
NPI:1962715433
Name:SAMPSON, SUSAN M (CAC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PEASE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-3024
Mailing Address - Country:US
Mailing Address - Phone:508-441-7983
Mailing Address - Fax:
Practice Address - Street 1:1625 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-1541
Practice Address - Country:US
Practice Address - Phone:401-762-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)