Provider Demographics
NPI:1558929059
Name:SAMUELS- WAITHE, MIZAMI MURIEL
Entity Type:Individual
Prefix:
First Name:MIZAMI
Middle Name:MURIEL
Last Name:SAMUELS- WAITHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3616
Mailing Address - Country:US
Mailing Address - Phone:646-932-5880
Mailing Address - Fax:
Practice Address - Street 1:1663 MISSION ST STE 604
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2473
Practice Address - Country:US
Practice Address - Phone:415-474-7310
Practice Address - Fax:510-227-1070
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty