Basic Information
| Provider Information | |||||||||
| NPI: | 1245836394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRONIN | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 MAIN ST UNIT 714-C | ||||||||
| Address2: | |||||||||
| City: | YARMOUTH PORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026752000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178693740 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 MAIN ST UNIT 714-C | ||||||||
| Address2: | |||||||||
| City: | YARMOUTH PORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026752000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178693740 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2020 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 11969 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.