Provider Demographics
NPI:1326874264
Name:SAMUEL, DANIEL (LSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5775
Mailing Address - Country:US
Mailing Address - Phone:847-454-5435
Mailing Address - Fax:
Practice Address - Street 1:1701 E LAKE AVE STE 374
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2065
Practice Address - Country:US
Practice Address - Phone:847-906-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150108625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker