Deirdre Kennedy Samuelsson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LICSW111460 Issued in MA

Practice address

66 Clifton Ave
Marblehead, MA 01945-1737

Phone

(781) 631-8273

NPI assigned

May 8, 2015

Sex

Female

Sole proprietor

No

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.

• Marblehead Counseling Center Inc

  • Counselor
  • Marblehead, MA
  • NPI 1205915857
  NPD

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1821476938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 CLIFTON AVE",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "019451737",
            "telephone_number": "781-631-8273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 CLIFTON AVE",
            "city": "MARBLEHEAD",
            "state": "MA",
            "postal_code": "019451737",
            "telephone_number": "781-631-8273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSSON",
        "first_name": "DEIRDRE",
        "middle_name": "KENNEDY",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-08",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW111460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Edward Rubin, M.D.
• Gianna Alexandria Ruiz
• Bryan T Ruocco, DC
• Ara Sakayan, P.T.
• Laura Ann Salvi, RN
• Stuart M Sandfield, D.M.D.
• Rachael Catherine Saulnier
• Stephanie Savasta, LIC. AC
• Jennifer Kennedy Scala, REGISTERED DIETITIAN
• Marisa Anne Schisler

• Clinical Social Worker in Marblehead, MA
• Providers in Marblehead, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.