Provider Demographics
NPI:1386725539
Name:MARWIT, SAMUEL JOEL (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JOEL
Last Name:MARWIT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 CLAYTON RD.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-644-2999
Mailing Address - Fax:
Practice Address - Street 1:7411 CLAYTON RD.
Practice Address - Street 2:SUITE 106
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-644-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00063103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO71164Medicare ID - Type Unspecified