Provider Demographics
NPI:1417010117
Name:FINK, SAMUEL HAROLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:HAROLD
Last Name:FINK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HARTZELL DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-1123
Mailing Address - Country:US
Mailing Address - Phone:304-870-4908
Mailing Address - Fax:
Practice Address - Street 1:1932 VIKING DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2460
Practice Address - Country:US
Practice Address - Phone:507-281-6240
Practice Address - Fax:507-281-6247
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1397103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN296848700Medicaid
MN680000079Medicare ID - Type Unspecified