Provider Demographics
NPI:1215400973
Name:SAMSON, RAPHAEL FREDRIC
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:FREDRIC
Last Name:SAMSON
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 1:10 INDUSTRIAL WAY E
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3332
Mailing Address - Country:US
Mailing Address - Phone:732-935-2220
Mailing Address - Fax:
Practice Address - Street 1:10 INDUSTRIAL WAY E
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3332
Practice Address - Country:US
Practice Address - Phone:732-935-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health