Provider Demographics
NPI:1598547556
Name:DEJEU, SAMUEL (PRS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:DEJEU
Suffix:
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-2136
Mailing Address - Country:US
Mailing Address - Phone:330-253-8803
Mailing Address - Fax:330-253-5992
Practice Address - Street 1:834 GRANT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-2136
Practice Address - Country:US
Practice Address - Phone:330-253-8803
Practice Address - Fax:330-253-5992
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003892175T00000X
OH187844101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist