Provider Demographics
NPI:1295418697
Name:KING, SAMUEL BARNARD JR (STUDENT MSW/MPH)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BARNARD
Last Name:KING
Suffix:JR
Gender:M
Credentials:STUDENT MSW/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1325
Mailing Address - Country:US
Mailing Address - Phone:908-352-8375
Mailing Address - Fax:908-352-8858
Practice Address - Street 1:655 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1325
Practice Address - Country:US
Practice Address - Phone:908-352-8375
Practice Address - Fax:908-352-8858
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical