Provider Demographics
NPI:1376604751
Name:SAMUELS, RICHARD M
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:M
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:B3A-320
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:480-661-9896
Mailing Address - Fax:480-661-5292
Practice Address - Street 1:8776 E SHEA BLVD
Practice Address - Street 2:B3A-320
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6629
Practice Address - Country:US
Practice Address - Phone:480-661-9896
Practice Address - Fax:480-661-5292
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ669425Medicare ID - Type UnspecifiedMEDICARE NUMBER