MEDICARE: DR. SAMANTHA MINA BEHBAHANI PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY8003	FL

General Provider Information

NPI Number	:	1023345386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA MINA BEHBAHANI PSY.D.

Provider Business Mailing Address
First Line	:	808 BRICKELL KEY DR
Second Line	:	APT 3408
City	:	MIAMI
State	:	FL
Zip	:	33131-2651
Country	:	US
Telephone Number	:	786-425-3262
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 SW 3RD AVE
Second Line	:	SUITE 202-A
City	:	MIAMI
State	:	FL
Zip	:	33129-2300
Country	:	US
Telephone Number	:	305-791-2374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	05/16/2014

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