Provider Demographics
NPI:1235892696
Name:SAMUEL, MARTINA ADEL
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:ADEL
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:ADEL FAWZY
Other - Last Name:SAMOEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7213 ANDERSONS FORGE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-7461
Mailing Address - Country:US
Mailing Address - Phone:804-319-5484
Mailing Address - Fax:
Practice Address - Street 1:6315 5TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1325
Practice Address - Country:US
Practice Address - Phone:202-671-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool