Basic Information
| Provider Information | |||||||||
| NPI: | 1962799965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEIANA | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 FERNBROOK RD | ||||||||
| Address2: | |||||||||
| City: | NORTHBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015321863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082544167 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 MERRICK ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016091937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087976100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2011 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.