Healthcare Provider Details

I. General information

NPI: 1124118476
Provider Name (Legal Business Name): SAMUEL GERARD FALCONE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 STEPHENSON AVE PATTERSON ARMY HEALTH CLINIC, ATTN: CREDENTIALS OFFICE
FORT MONMOUTH NJ
07703-1518
US

IV. Provider business mailing address

13030 HUNTERBROOK DR
WOODBRIDGE VA
22192-2468
US

V. Phone/Fax

Practice location:
  • Phone: 732-532-0182
  • Fax: 732-532-0194
Mailing address:
  • Phone: 703-915-5718
  • Fax: 703-494-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002363
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: