Provider Demographics
NPI:1801938527
Name:SAMUELSON, EMILY M (PHD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:M
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 ALLEGHENY AVE
Mailing Address - Street 2:SUITE 1305
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3909
Mailing Address - Country:US
Mailing Address - Phone:410-296-7715
Mailing Address - Fax:410-377-8468
Practice Address - Street 1:28 ALLEGHENY AVE
Practice Address - Street 2:SUITE 1305
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3909
Practice Address - Country:US
Practice Address - Phone:410-296-7715
Practice Address - Fax:410-377-8468
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD#2679103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist