Provider Demographics
NPI:1962829549
Name:ALBRIGHT, SAMUEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62-02 WOODSIDE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:718-898-5085
Mailing Address - Fax:
Practice Address - Street 1:62-02 WOODSIDE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-898-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089647-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT60644787OtherDRIVERS LICENSE