Healthcare Provider Details

I. General information

NPI: 1588676894
Provider Name (Legal Business Name): ANAT SAMID LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 PRINCETON KINGSTON RD
PRINCETON NJ
08540-4129
US

IV. Provider business mailing address

1073 PRINCETON KINGSTON RD
PRINCETON NJ
08540-4129
US

V. Phone/Fax

Practice location:
  • Phone: 917-207-6509
  • Fax:
Mailing address:
  • Phone: 917-207-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12013
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC05453000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: