MEDICARE: DR. ERIC ABRAHAM SAMUELS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	29311	CA

General Provider Information

NPI Number	:	1891079661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC ABRAHAM SAMUELS PSYD

Provider Business Mailing Address
First Line	:	PO BOX 24033
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94623-1033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 AQUA VISTA RD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94805-2028
Country	:	US
Telephone Number	:	203-747-1220
Fax Number	:	203-747-1220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	03/17/2018

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