Provider Demographics
NPI:1366726606
Name:ASUMADU, SAMUEL (LMSW, CASAC, ICADC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ASUMADU
Suffix:
Gender:M
Credentials:LMSW, CASAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5105
Mailing Address - Country:US
Mailing Address - Phone:718-621-1334
Mailing Address - Fax:
Practice Address - Street 1:2211 ELLIS AVENUE
Practice Address - Street 2:RM. 46
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5105
Practice Address - Country:US
Practice Address - Phone:347-621-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12764101YA0400X
NY092505104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)