Samantha Anne Boutin

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

46.003996 Issued in CT

Practice address

10 N Main St Ste 305
West Hartford, CT 06107-1901

Phone

(203) 240-7075

NPI assigned

Nov 15, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mana Psychological Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Hartford, CT
  • NPI 1033759196
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1568007367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 N MAIN ST STE 305",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061071901",
            "telephone_number": "203-240-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N MAIN ST STE 305",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061071901",
            "telephone_number": "203-240-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTIN",
        "first_name": "SAMANTHA",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "46.003996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Bossie
• Megan Bosworth, MA, ATC
• Claire Botting, ATC
• Boulevard Chiropractic & Wellness Center
• Shyla Boutilier
• Douglas Bowie
• Sahirah Boyd
• Carol Ann Bozena, MSW LCSW
• Michelle Bracha
• Robert Locke Bradbury, DMD

• Professional Counselor in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.