Provider Demographics
NPI:1770689804
Name:SAMPSEL, BRUCE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:SAMPSEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 11TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4422
Mailing Address - Country:US
Mailing Address - Phone:330-832-9370
Mailing Address - Fax:
Practice Address - Street 1:2285 BENDEN DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2568
Practice Address - Country:US
Practice Address - Phone:330-264-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSACP07104Medicare ID - Type Unspecified