Provider Demographics
NPI:1720868466
Name:HUSTH, SAM
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:HUSTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHAGBARK LN
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1807
Mailing Address - Country:US
Mailing Address - Phone:609-235-7923
Mailing Address - Fax:
Practice Address - Street 1:6 CHERRY BROOK LN
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1245
Practice Address - Country:US
Practice Address - Phone:732-979-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062649001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical