Basic Information
| Provider Information | |||||||||
| NPI: | 1124452529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAIORI | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | C/O BRIDGEPORT HOSPITAL REACH PROGRAM | ||||||||
| Address2: | 1558 BARNUM AVE. | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066103238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033843653 | ||||||||
| FaxNumber: | 2033788578 | ||||||||
| Practice Location | |||||||||
| Address1: | 91-2301 OLD FT WEAVER RD | ||||||||
| Address2: | |||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967063602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086718511 | ||||||||
| FaxNumber: | 8086772570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2013 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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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 | LSW-2054 | HI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 010141 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW-4134 | HI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.