Provider Demographics
NPI:1487757621
Name:SOBEL, SAM (LCSW)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:SOBEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13876 QUEENS BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2930
Mailing Address - Country:US
Mailing Address - Phone:718-850-3645
Mailing Address - Fax:718-526-7971
Practice Address - Street 1:13876 QUEENS BLVD FL 1
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2930
Practice Address - Country:US
Practice Address - Phone:718-850-3645
Practice Address - Fax:718-526-7971
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0256FVOtherMEDICARE GHI
7479547OtherGHI
P1971101OtherOXFORD