Provider Demographics
NPI:1154636827
Name:SAMUELS, EMILY DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DIANE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DIANE
Other - Last Name:HAJAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:934 N UNIVERSITY DR
Mailing Address - Street 2:PMB 206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7029
Mailing Address - Country:US
Mailing Address - Phone:954-885-9500
Mailing Address - Fax:954-885-9444
Practice Address - Street 1:3349 N UNIVERSITY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-9000
Practice Address - Country:US
Practice Address - Phone:954-885-9500
Practice Address - Fax:954-885-9444
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical