Provider Demographics
NPI:1487003232
Name:SAMUELS, MATTHEW (MA, LAC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2964
Mailing Address - Country:US
Mailing Address - Phone:732-492-8898
Mailing Address - Fax:
Practice Address - Street 1:17 HARPER RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2964
Practice Address - Country:US
Practice Address - Phone:732-492-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00310700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health