Provider Demographics
NPI:1104590306
Name:SAMUELS, SARA (LMFT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 JFK BLVD STE 1406
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7437
Mailing Address - Country:US
Mailing Address - Phone:215-840-6253
Mailing Address - Fax:
Practice Address - Street 1:1800 JFK BLVD STE 1406
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7437
Practice Address - Country:US
Practice Address - Phone:215-840-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist