Provider Demographics
NPI:1962538264
Name:ALBERT, SAMUEL (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:ALBERT
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 1:3515 SAINT PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4344
Mailing Address - Country:US
Mailing Address - Phone:612-925-2037
Mailing Address - Fax:612-926-7178
Practice Address - Street 1:1700 HIGHWAY 36 W
Practice Address - Street 2:SUITE 516
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4034
Practice Address - Country:US
Practice Address - Phone:651-631-1090
Practice Address - Fax:612-926-7178
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1718103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical