MEDICARE: MRS. CARMELITA REYES SAMUEL LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801082065	MI

General Provider Information

NPI Number	:	1548569841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMELITA REYES SAMUEL LMSW

Provider Business Mailing Address
First Line	:	1130 TIENKEN CT
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48306-4367
Country	:	US
Telephone Number	:	248-291-7216
Fax Number	:	248-221-5518

Provider Business Practice Location Address
First Line	:	1130 TIENKEN CT STE 223
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4370
Country	:	US
Telephone Number	:	248-291-7216
Fax Number	:	313-561-0709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	04/13/2021

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