Provider Demographics
NPI:1629319173
Name:SAMUOLIS, VINCENT ARTHUR (LCSW, LADC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ARTHUR
Last Name:SAMUOLIS
Suffix:
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WHITE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2165
Mailing Address - Country:US
Mailing Address - Phone:203-804-6251
Mailing Address - Fax:203-453-0170
Practice Address - Street 1:251 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2357
Practice Address - Country:US
Practice Address - Phone:203-804-6251
Practice Address - Fax:203-453-0170
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000277101YA0400X
CT0035441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)