MEDICARE: MRS. LAUREL MARCH SAMUELS PHD

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	PSY3248	CA

General Provider Information

NPI Number	:	1740364603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREL MARCH SAMUELS PHD

Provider Business Mailing Address
First Line	:	3628 SACRAMENTO STREET
Second Line	:	NO 6
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1753
Country	:	US
Telephone Number	:	415-775-2161
Fax Number	:	415-332-8600

Provider Business Practice Location Address
First Line	:	3628 SACRAMENTO STREET
Second Line	:	NO 6
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1753
Country	:	US
Telephone Number	:	415-775-2161
Fax Number	:	415-332-8600

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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