1124118476 NPI number — MR. SAMUEL GERARD FALCONE LCSW

Table of content: MR. SAMUEL GERARD FALCONE LCSW (NPI 1124118476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124118476 NPI number — MR. SAMUEL GERARD FALCONE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALCONE
Provider First Name:
SAMUEL
Provider Middle Name:
GERARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124118476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13030 HUNTERBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22192-2468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-915-5718
Provider Business Mailing Address Fax Number:
703-494-0735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 STEPHENSON AVE
Provider Second Line Business Practice Location Address:
PATTERSON ARMY HEALTH CLINIC, ATTN: CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
FORT MONMOUTH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07703-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-532-0182
Provider Business Practice Location Address Fax Number:
732-532-0194
Provider Enumeration Date:
10/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904002363 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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