Provider Demographics
NPI:1346322807
Name:TAUBE, SAMUEL R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:R
Last Name:TAUBE
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 1:139-B MAIN ST.
Mailing Address - Street 2:P.O. BOX 507
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0507
Mailing Address - Country:US
Mailing Address - Phone:631-751-5191
Mailing Address - Fax:631-751-1860
Practice Address - Street 1:139-B MAIN ST.
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-0507
Practice Address - Country:US
Practice Address - Phone:631-751-5191
Practice Address - Fax:631-751-1860
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW R0307041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical