Basic Information
| Provider Information | |||||||||
| NPI: | 1336741172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ST-AUBIN | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 97 OLD KENNEDY RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060952022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604626036 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1680 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602364511 | ||||||||
| FaxNumber: | 8602318449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2020 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 4620 | CT | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 11465 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.