Provider Demographics
NPI:1306205661
Name:PATRICIA A. MUROSKI-SAMUL, LCSW, P.C.
Entity Type:Organization
Organization Name:PATRICIA A. MUROSKI-SAMUL, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUROSKI-SAMUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-947-5446
Mailing Address - Street 1:14153 SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:NY
Mailing Address - Zip Code:13156-3159
Mailing Address - Country:US
Mailing Address - Phone:315-947-5446
Mailing Address - Fax:
Practice Address - Street 1:14153 SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:NY
Practice Address - Zip Code:13156-3159
Practice Address - Country:US
Practice Address - Phone:315-947-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0409811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199026Medicaid
NYS54073Medicare UPIN
NYBB0585Medicare PIN