Provider Demographics
NPI:1558801431
Name:DIMISA, SAMANTHA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:DIMISA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:50 BARROW ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3740
Mailing Address - Country:US
Mailing Address - Phone:516-652-4477
Mailing Address - Fax:646-836-7712
Practice Address - Street 1:150 PARK ROW
Practice Address - Street 2:NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1704
Practice Address - Country:US
Practice Address - Phone:646-836-6335
Practice Address - Fax:646-836-7712
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020282-01103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic