Provider Demographics
NPI:1144697806
Name:SAMAR, STEPHANIE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:SAMAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MADISON AVE STE 1406
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4325
Mailing Address - Country:US
Mailing Address - Phone:646-475-0922
Mailing Address - Fax:646-948-9270
Practice Address - Street 1:185 MADISON AVE STE 1406
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4325
Practice Address - Country:US
Practice Address - Phone:646-475-0922
Practice Address - Fax:646-948-9270
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical