Provider Demographics
NPI:1760795884
Name:SAMUELOWITZ, JONAH BRETT (LMSW/MSW)
Entity Type:Individual
Prefix:MR
First Name:JONAH
Middle Name:BRETT
Last Name:SAMUELOWITZ
Suffix:
Gender:M
Credentials:LMSW/MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3516
Mailing Address - Country:US
Mailing Address - Phone:631-874-2700
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3516
Practice Address - Country:US
Practice Address - Phone:631-874-2700
Practice Address - Fax:631-874-3786
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081477-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker