Provider Demographics
NPI:1588676894
Name:SAMID, ANAT (LCSW)
Entity Type:Individual
Prefix:
First Name:ANAT
Middle Name:
Last Name:SAMID
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 1:1073 PRINCETON KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4129
Mailing Address - Country:US
Mailing Address - Phone:917-207-6509
Mailing Address - Fax:
Practice Address - Street 1:1073 PRINCETON KINGSTON RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-4129
Practice Address - Country:US
Practice Address - Phone:917-207-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12013104100000X
NJ44SC05453000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7073804OtherAETNA
MD7964200Medicaid
DCA2840157OtherBCBS OF DC
MD65050101OtherBCBS OF MD
MD7964200Medicaid