Provider Demographics
NPI:1285997049
Name:SAMUELS, ANN MARIE (MSC (SPECIAL ED))
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MSC (SPECIAL ED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17930 144TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5950
Mailing Address - Country:US
Mailing Address - Phone:718-527-3561
Mailing Address - Fax:
Practice Address - Street 1:17930 144TH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5950
Practice Address - Country:US
Practice Address - Phone:718-527-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY900B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist