Provider Demographics
NPI:1518032457
Name:DELAGARZA, SAMANTHA M (PHD)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:M
Last Name:DELAGARZA
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 1:10708 CORBY CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3583
Mailing Address - Country:US
Mailing Address - Phone:402-891-8300
Mailing Address - Fax:402-891-8301
Practice Address - Street 1:10708 CORBY CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3583
Practice Address - Country:US
Practice Address - Phone:402-891-8300
Practice Address - Fax:402-891-8301
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08229OtherBLUE CROSS BLUE SHIELD
NE47080935726Medicaid
NE08229OtherBLUE CROSS BLUE SHIELD