Basic Information
| Provider Information | |||||||||
| NPI: | 1124118476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALCONE | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | GERARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13030 HUNTERBROOK DR | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221922468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039155718 | ||||||||
| FaxNumber: | 7034940735 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 STEPHENSON AVE | ||||||||
| Address2: | PATTERSON ARMY HEALTH CLINIC, ATTN: CREDENTIALS OFFICE | ||||||||
| City: | FORT MONMOUTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077031518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325320182 | ||||||||
| FaxNumber: | 7325320194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904002363 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.