Provider Demographics
NPI:1740364603
Name:SAMUELS, LAUREL MARCH (PHD)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:MARCH
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:LARUEL
Other - Middle Name:MARCH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3628 SACRAMENTO STREET
Mailing Address - Street 2:NO 6
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1753
Mailing Address - Country:US
Mailing Address - Phone:415-775-2161
Mailing Address - Fax:415-332-8600
Practice Address - Street 1:3628 SACRAMENTO STREET
Practice Address - Street 2:NO 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1753
Practice Address - Country:US
Practice Address - Phone:415-775-2161
Practice Address - Fax:415-332-8600
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical