Provider Demographics
NPI:1386969574
Name:GILES, SAMUEL JOSEPH (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:GILES
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23122 SUMMERS DREAM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3209
Mailing Address - Country:US
Mailing Address - Phone:210-833-0720
Mailing Address - Fax:210-221-6354
Practice Address - Street 1:CMR 402
Practice Address - Street 2:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-3460
Practice Address - Country:US
Practice Address - Phone:49637-186-8590
Practice Address - Fax:49637-186-6133
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW-41OtherLICENSED CLINICAL SOCIAL WORKER FOR PRIVATE AND INDEPENDENT PRACTICE