Wallace, Samantha Cooper

Wallace, Samantha Cooper is an individual health care provider with primary practice located at 205 Burlington Rd , Bedford MA 01730-1406. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as her primary health care specialty. Wallace, Samantha Cooper can be contacted via phone (781) 761-5089.

Contact Information

Primary practice address
205 Burlington Rd Bedford MA 01730-1406
Phone: (781) 761-5089
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1790457158
LBN Legal business name Wallace, Samantha Cooper
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2021
Last updated Oct 4th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790457158 NPPES
Massachusetts Other 1004745 NHP
Massachusetts Other 0000023532 NHP
Massachusetts Other 1004745 NHP
Massachusetts Other 1303287 NHP
Massachusetts Other M18633 NHP
Massachusetts Other 042611055 NHP
Massachusetts Other 99618201 NHP

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