Provider Demographics
NPI:1215969514
Name:SAMUELS, SEAN ERIC (PSYD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ERIC
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9227
Mailing Address - Country:US
Mailing Address - Phone:402-483-6990
Mailing Address - Fax:402-483-7045
Practice Address - Street 1:4545 S 86TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9227
Practice Address - Country:US
Practice Address - Phone:402-483-6990
Practice Address - Fax:402-483-7045
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE624103G00000X, 103T00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024969000Medicaid
NE47079871700Medicaid
NE10024968900Medicaid
NE470798717-26Medicaid
NE470798717-27Medicaid
NE470798717-29Medicaid
NE246565OtherMIDLANDS CHOICE
NED80001OtherBCBS
NEQ49303Medicare UPIN
NE47079871700Medicaid