Provider Demographics
NPI:1205584430
Name:SAMUEL, MARY LAU (LSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LAU
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BUCKTAIL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-6133
Mailing Address - Country:US
Mailing Address - Phone:302-314-5122
Mailing Address - Fax:
Practice Address - Street 1:3522 SILVERSIDE RD STE 32
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4915
Practice Address - Country:US
Practice Address - Phone:443-553-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical