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Contact Information

BRADLEY W SAMUEL, PHD
2400 TUCKER NE
ALBUQUERQUE, NM87131-0001
 Phone: 505-272-1734
 Fax: 505-272-6308
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BRADLEY W SAMUEL · (Male)

NPI Number 1255363586
Status Active
Credentials PHD
Entity Individual
Enumeration date 07/07/2006
Last updated 05/22/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • NM License # 738
  • AZ Medicaid 955627
  • CO Medicaid 09702784
  • NM Other NM01JB06 BLUE SHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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