Provider Demographics
NPI:1487685244
Name:SAMY, EDWARD ANTONI (EDD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANTONI
Last Name:SAMY
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:PO BOX 64042
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94088-4042
Mailing Address - Country:US
Mailing Address - Phone:408-736-7675
Mailing Address - Fax:408-736-7675
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6093
Practice Address - Country:US
Practice Address - Phone:408-636-6141
Practice Address - Fax:408-736-7675
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16428103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling