Provider Demographics
NPI:1538216460
Name:SAMUEL, STEVEN ERIC (PHD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ERIC
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:ERIC
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:125 S 9TH ST
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5125
Mailing Address - Country:US
Mailing Address - Phone:215-829-0331
Mailing Address - Fax:215-829-0338
Practice Address - Street 1:125 S 9TH ST
Practice Address - Street 2:SUITE 1003
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5125
Practice Address - Country:US
Practice Address - Phone:215-829-0331
Practice Address - Fax:215-829-0338
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006031L103G00000X, 103TC0700X
103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic