Provider Demographics
NPI:1316556855
Name:SAMUEL, DANIELLE (MS, AAMFT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MS, AAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 PLUMMER ST APT 206
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2160
Mailing Address - Country:US
Mailing Address - Phone:408-508-2497
Mailing Address - Fax:
Practice Address - Street 1:8500 WILSHIRE BLVD STE 700C
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3105
Practice Address - Country:US
Practice Address - Phone:818-906-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist