Stacy Ann Samuels, MSED

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

8 Evergreen Cir
Dekalb, IL 60115-2214

Phone

(773) 217-4907

NPI assigned

Jun 7, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Respect Behavior Therapy

  • Community/Behavioral Health Agency
  • Forest Park, GA
  • NPI 1114639333

  Behavior Analyst

  NPD (past) Authorized official
• Pyramid Behavioral Health Inc

  • Behavior Analyst
  • Dekalb, IL
  • NPI 1083281851
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1992067755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 METROPOLITAN OVAL",
            "address_2": "#3F",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104626523",
            "telephone_number": "718-822-3873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 EVERGREEN CIR",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601152214",
            "telephone_number": "773-217-4907"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4024 Amboy Rd",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103082409",
            "country_code": "US",
            "telephone_number": "718-605-0642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "STACY ANN",
        "credential": "MSED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-07",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "134293071",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Salmon, LCPC
• Samantha Lyn Salvato, LPC
• Ted Samawi, D.O
• Kathryn Mary Sample, LCPC
• Karla Jo Sampson
• Samaria Sanders
• Sankofa Village NFP
• Janet Sarver
• Ericka Sasso, BSW
• Sakshi Sata, OD

• Behavior Analyst in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.