Provider Demographics
NPI:1902817455
Name:MUROSKI-SAMUL, PATRICIA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:MUROSKI-SAMUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:NY
Mailing Address - Zip Code:13156-3159
Mailing Address - Country:US
Mailing Address - Phone:315-947-5446
Mailing Address - Fax:
Practice Address - Street 1:33 E SCHUYLER ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1161
Practice Address - Country:US
Practice Address - Phone:315-343-6974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040980-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199026Medicaid
NY02199026Medicaid
NYBB0585Medicare ID - Type Unspecified