Healthcare Provider Details

I. General information

NPI: 1649998402
Provider Name (Legal Business Name): SAMUEL JOSEPH MORREALE III LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 GODWIN AVE
MIDLAND PARK NJ
07432-1519
US

IV. Provider business mailing address

317 GODWIN AVE
MIDLAND PARK NJ
07432-1519
US

V. Phone/Fax

Practice location:
  • Phone: 908-321-1331
  • Fax:
Mailing address:
  • Phone: 908-312-1331
  • Fax: 908-914-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06563800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: