Provider Demographics
NPI:1649616079
Name:HIOTAKIS, SAMANTHA (PSYD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:HIOTAKIS
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:PO BOX 5021
Mailing Address - Street 2:
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-4021
Mailing Address - Country:US
Mailing Address - Phone:631-255-7715
Mailing Address - Fax:
Practice Address - Street 1:12 OAK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2020
Practice Address - Country:US
Practice Address - Phone:631-255-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68020011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist