Provider Demographics
NPI:1912152703
Name:SAMANTHA T. BENDER, PH.D., LLC
Entity Type:Organization
Organization Name:SAMANTHA T. BENDER, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-718-2971
Mailing Address - Street 1:4915 AUBURN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2636
Mailing Address - Country:US
Mailing Address - Phone:301-718-2971
Mailing Address - Fax:301-718-2972
Practice Address - Street 1:4915 AUBURN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2636
Practice Address - Country:US
Practice Address - Phone:301-718-2971
Practice Address - Fax:301-718-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03615251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1770529109OtherINDIVIDUAL NPI
MD400939800Medicaid