Basic Information
| Provider Information | |||||||||
| NPI: | 1154879120 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERVETTI | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 LAMAR AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66202 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1125 W SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660613123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138264200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2016 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LMSW 10128 | KS | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 4999 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.