Provider Demographics
NPI:1801199377
Name:SAMUELS, DEBRA A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:VORRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1786 MOON LAKE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5029
Mailing Address - Country:US
Mailing Address - Phone:847-755-8090
Mailing Address - Fax:847-843-7393
Practice Address - Street 1:1786 MOON LAKE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5029
Practice Address - Country:US
Practice Address - Phone:847-755-8090
Practice Address - Fax:847-843-7393
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0047151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical