Provider Demographics
NPI:1972005882
Name:ADELSBERG, SAMANTHA (MA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ADELSBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 RIVERSIDE DR APT 14B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5247
Mailing Address - Country:US
Mailing Address - Phone:516-946-6969
Mailing Address - Fax:
Practice Address - Street 1:590 W END AVE APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1749
Practice Address - Country:US
Practice Address - Phone:516-828-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024602-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical