Provider Demographics
NPI:1962799965
Name:DEIANA, SAMANTHA (MSW)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:DEIANA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 FERNBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1863
Mailing Address - Country:US
Mailing Address - Phone:508-254-4167
Mailing Address - Fax:
Practice Address - Street 1:105 MERRICK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1937
Practice Address - Country:US
Practice Address - Phone:508-797-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical