Provider Demographics
NPI:1093400509
Name:SAMALIN, MATTHEW ELI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ELI
Last Name:SAMALIN
Suffix:
Gender:M
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:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-0133
Mailing Address - Country:US
Mailing Address - Phone:914-548-1668
Mailing Address - Fax:
Practice Address - Street 1:124 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12604-0001
Practice Address - Country:US
Practice Address - Phone:914-548-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025596-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist