Provider Demographics
NPI:1457694697
Name:SAMUELS-FOSTER, SADIE
Entity Type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:
Last Name:SAMUELS-FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3552
Mailing Address - Country:US
Mailing Address - Phone:516-876-6318
Mailing Address - Fax:516-571-9557
Practice Address - Street 1:682 UNION AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3552
Practice Address - Country:US
Practice Address - Phone:516-876-6318
Practice Address - Fax:516-571-9557
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07498911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical