Provider Demographics
NPI:1184942567
Name:MEDVED, SAMANTHA BULEY (LICSW)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:BULEY
Last Name:MEDVED
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JANE
Other - Last Name:BULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 WASHINGTON HWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8715
Mailing Address - Country:US
Mailing Address - Phone:802-888-7266
Mailing Address - Fax:802-888-3081
Practice Address - Street 1:530 WASHINGTON HWY
Practice Address - Street 2:SUITE 12
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8715
Practice Address - Country:US
Practice Address - Phone:802-888-7266
Practice Address - Fax:802-888-3081
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-0058237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist