Provider Demographics
NPI:1356404263
Name:ABDULLAH, SAMELLA BERRY (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMELLA
Middle Name:BERRY
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E 53RD ST
Mailing Address - Street 2:#531
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4557
Mailing Address - Country:US
Mailing Address - Phone:888-534-0369
Mailing Address - Fax:773-752-3271
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:#531
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:888-534-0369
Practice Address - Fax:773-752-3271
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW 62941041C0700X
IL149 00 37431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical