Provider Demographics
NPI:1073924304
Name:PARIS, SAMUEL (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:PARIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 NARRAGANSETT DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1924
Mailing Address - Country:US
Mailing Address - Phone:856-441-2678
Mailing Address - Fax:
Practice Address - Street 1:426 NARRAGANSETT DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1924
Practice Address - Country:US
Practice Address - Phone:856-441-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087480104100000X
PACW0201181041C0700X
NJ44SC057797001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker