Individual
MRS. GWENDOLYN PHILLIPS-SAMUELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 243-5600
(305) 243-4595
Mailing address
1601 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 243-5600
(305) 243-4595
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
753154100
FL
222Q00000X
Developmental Therapist
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
753154100
—
FL
Enumeration date
02/09/2007
Last updated
09/16/2016
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