Provider Demographics
NPI:1528506847
Name:AGYEI, SAMUEL (LMSW)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:AGYEI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:LARBI
Other - Last Name:AGYEI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:291 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1550
Mailing Address - Country:US
Mailing Address - Phone:860-997-3050
Mailing Address - Fax:
Practice Address - Street 1:291 COLLINS ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-997-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0017921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001792OtherLMSW