Provider Demographics
NPI:1790092229
Name:ORBACH, SAMANTHA NAOMI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:NAOMI
Last Name:ORBACH
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 1:2743 N WOLCOTT AVE UNIT 46
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1067
Mailing Address - Country:US
Mailing Address - Phone:847-370-7264
Mailing Address - Fax:
Practice Address - Street 1:70 E LAKE ST STE 1300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7458
Practice Address - Country:US
Practice Address - Phone:847-370-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
IL071008771103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional