Provider Demographics
NPI:1174190912
Name:SAMUTO, TENE NGUENKEP
Entity Type:Individual
Prefix:
First Name:TENE
Middle Name:NGUENKEP
Last Name:SAMUTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FLANNERY LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1269
Mailing Address - Country:US
Mailing Address - Phone:240-264-0865
Mailing Address - Fax:
Practice Address - Street 1:200 FLANNERY LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1269
Practice Address - Country:US
Practice Address - Phone:240-264-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician