Provider Demographics
NPI:1073903506
Name:SAMARDZIJA PSYCHOLOGICAL CENTER
Entity Type:Organization
Organization Name:SAMARDZIJA PSYCHOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARDZIJA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-962-9195
Mailing Address - Street 1:12900 SANDIA POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8198
Mailing Address - Country:US
Mailing Address - Phone:630-962-9195
Mailing Address - Fax:
Practice Address - Street 1:12900 SANDIA POINT RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-8198
Practice Address - Country:US
Practice Address - Phone:630-962-9195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty