Provider Demographics
NPI:1730142985
Name:SAMSON, LAURA P (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:P
Last Name:SAMSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WHITE POND DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1127
Mailing Address - Country:US
Mailing Address - Phone:330-572-1011
Mailing Address - Fax:330-572-1018
Practice Address - Street 1:701 WHITE POND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1127
Practice Address - Country:US
Practice Address - Phone:330-572-1011
Practice Address - Fax:330-572-1018
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2473836Medicaid
CP29791Medicare PIN