Provider Demographics
NPI:1578871851
Name:MCBRIDE, SAMANTHA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13199 E MONTVIEW BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7209
Mailing Address - Country:US
Mailing Address - Phone:303-724-3300
Mailing Address - Fax:
Practice Address - Street 1:13199 E MONTVIEW BLVD STE 330
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7209
Practice Address - Country:US
Practice Address - Phone:303-724-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12744135OtherCAQH