Provider Demographics
NPI:1346020500
Name:EVERSLEY, SAMEL SAMONA
Entity Type:Individual
Prefix:
First Name:SAMEL
Middle Name:SAMONA
Last Name:EVERSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-5216
Mailing Address - Country:US
Mailing Address - Phone:347-798-6150
Mailing Address - Fax:
Practice Address - Street 1:898 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5216
Practice Address - Country:US
Practice Address - Phone:347-798-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool