Provider Demographics
NPI:1548569841
Name:SAMUEL, CARMELITA REYES (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CARMELITA
Middle Name:REYES
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TIENKEN CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4367
Mailing Address - Country:US
Mailing Address - Phone:248-291-7216
Mailing Address - Fax:248-221-5518
Practice Address - Street 1:1130 TIENKEN CT STE 223
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4370
Practice Address - Country:US
Practice Address - Phone:248-291-7216
Practice Address - Fax:313-561-0709
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010820651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical