Provider Demographics
NPI:1417543687
Name:SAMUELS, HVANNA GEORGENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HVANNA
Middle Name:GEORGENE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 MAIN ST UNIT 207
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4258
Mailing Address - Country:US
Mailing Address - Phone:203-400-4567
Mailing Address - Fax:
Practice Address - Street 1:991 MAIN ST UNIT 207
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4258
Practice Address - Country:US
Practice Address - Phone:203-308-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT112091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical