Provider Demographics
NPI:1780824243
Name:STANTON E. SAMENOW, PH.D., P.C.
Entity Type:Organization
Organization Name:STANTON E. SAMENOW, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAMENOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-931-0004
Mailing Address - Street 1:4921 SEMINARY ROAD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311
Mailing Address - Country:US
Mailing Address - Phone:703-931-0004
Mailing Address - Fax:703-379-7288
Practice Address - Street 1:4921 SEMINARY ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311
Practice Address - Country:US
Practice Address - Phone:703-931-0004
Practice Address - Fax:703-379-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA. LIC. #621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty