Provider Demographics
NPI:1780477174
Name:BIRK, SAMANTHA LYNN (PHD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:BIRK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6000
Mailing Address - Street 2:INSTITUTE FOR CHILD DEVELOPMENT
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13902
Mailing Address - Country:US
Mailing Address - Phone:607-777-2829
Mailing Address - Fax:
Practice Address - Street 1:4400 VESTAL PARKWAY EAST BINGHAMTON UNIVERSITY
Practice Address - Street 2:INSTITUTE FOR CHILD DEVELOPMENT
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902
Practice Address - Country:US
Practice Address - Phone:607-777-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026902103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist