SHELLEY MAUREEN SAMUELS
NPI 1194273821
Counselor - Professional in San Francisco, CA

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101YP2500X and a focus in Professional.

Active since September 11, 2016

368 FELL ST, SAN FRANCISCO, CA 94102(415) 861-0828(415) 861-0257 Get Directions Write a Review

NPPES record last updated: April 2, 2018. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Shelley Maureen Samuels NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELLEY MAUREEN SAMUELS (NPI 1194273821) is an individual professional provider in San Francisco, California, licensed in California (1635) and active in the NPI registry since September 2016. She maintains a secondary practice location in Berkeley.

NPPES Registry Identity

NPI1194273821

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameSHELLEY MAUREEN SAMUELS

Location Address368 FELL STSan Francisco, CA 94102-5144

Mailing Address368 Fell StSan Francisco, CA 94102-5144 · (415) 861-0828 · Fax (415) 861-0257

Phone(415) 861-0828

Fax(415) 861-0257

Sole ProprietorNo

Enumeration DateSeptember 11, 2016

Last NPPES UpdateApril 2, 2018

✔ NPI 1194273821 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in CA · 1635

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License PCCI 1635 (CA)

368 FELL ST, San Francisco, CA 94102

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Secondary Practice Location 1

Location 12712 Telegraph AveBerkeley, CA 94705-1117 · Phone (510) 548-8283 ext. 125

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Shelley Maureen Samuels has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2026.

Opt-Out Effective DateJanuary 1, 2024

Opt-Out In Effect ThroughJanuary 1, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. NICOLE RUFFIN LEONARD

Counselor