Basic Information
| Provider Information | |||||||||
| NPI: | 1134489826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EWART | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 VALLEY RD | ||||||||
| Address2: | APT B | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425236 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 31 JOHN CLARKE RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018492300 | ||||||||
| FaxNumber: | 4018484156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2012 | ||||||||
| LastUpdateDate: | 04/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 217910 | MA | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | CSW01538 | RI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.