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General NPI Number Information
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NPI Number | 1124118476
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Entity Type | Individual
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Provider Name | SAMUEL GERARD FALCONE LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1075 STEPHENSON AVE PATTERSON ARMY HEALTH CLINIC, ATTN: CREDENTIALS OFFICE
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City | FORT MONMOUTH
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State | NJ
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Zip | 07703-1518
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Country | US
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Telephone | 732-532-0182
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Fax | 732-532-0194
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Provider Business Mailing Address
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Address Line | 13030 HUNTERBROOK DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2468
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Country | US
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Telephone | 703-915-5718
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Fax | 703-494-0735
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904002363
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License Number State | VA
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