Provider Demographics
NPI:1356660310
Name:SAMSEL, SAMUEL SAYLOR III (LSW)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:SAYLOR
Last Name:SAMSEL
Suffix:III
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-7144
Mailing Address - Fax:856-355-7143
Practice Address - Street 1:534 LIPPINCOTT DR STE B
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4805
Practice Address - Country:US
Practice Address - Phone:856-355-7144
Practice Address - Fax:856-355-7143
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05543900104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker