Provider Demographics
NPI:1013797026
Name:MEISEL, SAMUEL NOAH (PHD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:NOAH
Last Name:MEISEL
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 1:91 MAIN ST APT 328
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-4432
Mailing Address - Country:US
Mailing Address - Phone:201-334-7299
Mailing Address - Fax:
Practice Address - Street 1:91 MAIN ST APT 328
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-4432
Practice Address - Country:US
Practice Address - Phone:201-334-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02026103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical