Provider Demographics
NPI:1225631542
Name:NELSON, SAMUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DRAKE LN
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1228
Mailing Address - Country:US
Mailing Address - Phone:347-502-2849
Mailing Address - Fax:
Practice Address - Street 1:18 KAF-BET YALDEI MAALOT
Practice Address - Street 2:
Practice Address - City:SAFED
Practice Address - State:SAFED
Practice Address - Zip Code:1323200
Practice Address - Country:IL
Practice Address - Phone:050-430-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical