Healthcare Provider Details

I. General information

NPI: 1699355636
Provider Name (Legal Business Name): OFFICE OF CARMELITA R SAMUEL,MSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TIENKEN CT STE 233
ROCHESTER HLS MI
48306-4367
US

IV. Provider business mailing address

1130 TIENKEN CT STE 223
ROCHESTER HILLS MI
48306-4370
US

V. Phone/Fax

Practice location:
  • Phone: 248-291-7216
  • Fax: 248-221-5518
Mailing address:
  • Phone: 248-291-7216
  • Fax: 248-221-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PROF. CARMELITA REYES SAMUEL
Title or Position: OWNER
Credential: LMSW
Phone: 248-291-7216