Provider Demographics
NPI:1598811390
Name:SAMUELS, KAREN LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E. GRANADA BOULEVARD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6634
Mailing Address - Country:US
Mailing Address - Phone:386-255-1646
Mailing Address - Fax:386-671-3002
Practice Address - Street 1:115 E. GRANADA BOULEVARD
Practice Address - Street 2:SUITE 7
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6634
Practice Address - Country:US
Practice Address - Phone:386-255-1646
Practice Address - Fax:386-671-3002
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical