Provider Demographics
NPI:1447640651
Name:SAMARA, EMILY (MA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SAMARA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LYMAN MDW
Mailing Address - Street 2:UNIT I1
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-9429
Mailing Address - Country:US
Mailing Address - Phone:802-233-0412
Mailing Address - Fax:
Practice Address - Street 1:1 MILL ST
Practice Address - Street 2:SUITE 214
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1530
Practice Address - Country:US
Practice Address - Phone:802-233-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0095258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist