Provider Demographics
NPI:1417175092
Name:SKEAN, SAMUEL RAYMOND (EDD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RAYMOND
Last Name:SKEAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2736
Mailing Address - Country:US
Mailing Address - Phone:732-214-0447
Mailing Address - Fax:732-846-0654
Practice Address - Street 1:12 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2736
Practice Address - Country:US
Practice Address - Phone:732-214-0447
Practice Address - Fax:732-846-0654
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2253103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling