Provider Demographics
NPI:1235276460
Name:AKSAMIT, PAT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAT
Middle Name:
Last Name:AKSAMIT
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 1:3350 AMERICANA TER
Mailing Address - Street 2:SUITE300
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2521
Mailing Address - Country:US
Mailing Address - Phone:208-343-1113
Mailing Address - Fax:208-343-0040
Practice Address - Street 1:3350 AMERICANA TER
Practice Address - Street 2:SUITE300
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2521
Practice Address - Country:US
Practice Address - Phone:208-343-1113
Practice Address - Fax:208-343-0040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC68101YP2500X
IDPSY372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDBC Q8682OtherBLUE CROSS PROVIDER
ID000010017682OtherBLUE SHEILD PROVIDER
IDBC Q8682OtherBLUE CROSS PROVIDER