Provider Demographics
NPI:1497969182
Name:SAMUELS, CAROLYN BROOKE (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:BROOKE
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 1:353 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3863
Mailing Address - Country:US
Mailing Address - Phone:732-679-6700
Mailing Address - Fax:
Practice Address - Street 1:3342 US HIGHWAY 9
Practice Address - Street 2:DEEP RUN PLAZA
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2685
Practice Address - Country:US
Practice Address - Phone:732-679-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045835001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical