Provider Demographics
NPI:1699355636
Name:OFFICE OF CARMELITA R SAMUEL,MSW PLLC
Entity Type:Organization
Organization Name:OFFICE OF CARMELITA R SAMUEL,MSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-291-7216
Mailing Address - Street 1:1130 TIENKEN CT STE 223
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4370
Mailing Address - Country:US
Mailing Address - Phone:248-291-7216
Mailing Address - Fax:248-221-5518
Practice Address - Street 1:1130 TIENKEN CT STE 233
Practice Address - Street 2:
Practice Address - City:ROCHESTER HLS
Practice Address - State:MI
Practice Address - Zip Code:48306-4367
Practice Address - Country:US
Practice Address - Phone:248-291-7216
Practice Address - Fax:248-221-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty