MEDICARE: DR. KAREN LEE SAMUELS PH.D.

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	103TC0700X	Clinical Psychologist	PY0004338	FL

General Provider Information

NPI Number	:	1598811390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN LEE SAMUELS PH.D.

Provider Business Mailing Address
First Line	:	115 E. GRANADA BOULEVARD
Second Line	:	SUITE 7
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-6634
Country	:	US
Telephone Number	:	386-255-1646
Fax Number	:	386-671-3002

Provider Business Practice Location Address
First Line	:	115 E. GRANADA BOULEVARD
Second Line	:	SUITE 7
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-6634
Country	:	US
Telephone Number	:	386-255-1646
Fax Number	:	386-671-3002

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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