Provider Demographics
NPI:1982089140
Name:OMELIAN, SAMANTHA (PHD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:OMELIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GULF TO BAY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4304
Mailing Address - Country:US
Mailing Address - Phone:800-687-1938
Mailing Address - Fax:
Practice Address - Street 1:3000 GULF TO BAY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4304
Practice Address - Country:US
Practice Address - Phone:800-687-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12029103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist