Provider Demographics
NPI:1811065188
Name:SAMEK, WILLIAM RICHARD (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RICHARD
Last Name:SAMEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7241 SW 63RD AVE STE 203-C
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4838
Mailing Address - Country:US
Mailing Address - Phone:305-552-5000
Mailing Address - Fax:305-552-5000
Practice Address - Street 1:7241 SW 63RD AVE STE 203-C
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4838
Practice Address - Country:US
Practice Address - Phone:305-552-5000
Practice Address - Fax:305-552-5000
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2915103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
75135Medicare ID - Type Unspecified