Provider Demographics
NPI:1891079661
Name:SAMUELS, ERIC ABRAHAM (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ABRAHAM
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24033
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-1033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1639 AQUA VISTA RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2028
Practice Address - Country:US
Practice Address - Phone:203-747-1220
Practice Address - Fax:203-747-1220
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical