Provider Demographics
NPI:1053915165
Name:ADAM, SAMUEL (LMHC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ADAM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BARNEY RD STE 234
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5835
Mailing Address - Country:US
Mailing Address - Phone:518-390-5014
Mailing Address - Fax:
Practice Address - Street 1:1 BARNEY RD STE 234
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-5835
Practice Address - Country:US
Practice Address - Phone:518-390-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health