Provider Demographics
NPI:1891074761
Name:JAMES, SAMUEL T (MA, CASAC-T, CPRP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:T
Last Name:JAMES
Suffix:
Gender:M
Credentials:MA, CASAC-T, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3215
Mailing Address - Country:US
Mailing Address - Phone:718-377-7757
Mailing Address - Fax:718-758-9491
Practice Address - Street 1:2037 UTICA AVE
Practice Address - Street 2:2FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3215
Practice Address - Country:US
Practice Address - Phone:718-377-7757
Practice Address - Fax:718-758-9497
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YP1600X
101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist