Provider Demographics
NPI:1184227100
Name:DR. SAMANTHA RAE PLLC
Entity Type:Organization
Organization Name:DR. SAMANTHA RAE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-759-5835
Mailing Address - Street 1:2212 S CHICKASAW TRL # 1013
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8414
Mailing Address - Country:US
Mailing Address - Phone:407-759-5835
Mailing Address - Fax:
Practice Address - Street 1:2564 CORBYTON CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7514
Practice Address - Country:US
Practice Address - Phone:407-759-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty