Healthcare Provider Details

I. General information

NPI: 1891074761
Provider Name (Legal Business Name): SAMUEL T. JAMES MA., CASAC-T., CPRP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 UTICA AVE 2FL
BROOKLYN NY
11234-3215
US

IV. Provider business mailing address

2037 UTICA AVE
BROOKLYN NY
11234-3215
US

V. Phone/Fax

Practice location:
  • Phone: 718-377-7757
  • Fax: 718-758-9497
Mailing address:
  • Phone: 718-377-7757
  • Fax: 718-758-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: