Provider Demographics
NPI:1588055818
Name:SAMUEL, VELANDA (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:VELANDA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3937
Mailing Address - Country:US
Mailing Address - Phone:860-597-7504
Mailing Address - Fax:
Practice Address - Street 1:360 BLOOMFIELD AVE
Practice Address - Street 2:STE 301
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2700
Practice Address - Country:US
Practice Address - Phone:860-597-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical