Active NPI
Deanne Samuels, PHD
- Clinical Psychologist
- Hollywood, FL
National Provider Identifier
1144859836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY18392
- Practice address
- 3856 SW 52ND Ave
Hollywood, FL 33023-6905 - Phone
- (786) 246-7121
- NPI assigned
- Apr 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY18392 | CA | Primary |
Addresses
Primary practice location
3856 SW 52ND Ave
Hollywood, FL 33023-6905
Mailing address
3856 SW 52ND Ave
Hollywood, FL 33023-6905
Phone (786) 246-7121
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200521000678 | FL | Practitioner - Clinical Psychologist | 8123459401 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585958400000",
"number": "1144859836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3856 SW 52ND AVE",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330236905",
"telephone_number": "786-246-7121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3856 SW 52ND AVE",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330236905",
"telephone_number": "786-246-7121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUELS",
"first_name": "DEANNE",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-04",
"last_updated": "2020-04-04",
"certification_date": "2020-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY18392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.