MEDICARE: DR. MITCHELL JAY SAMET PH.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	103T00000X	Psychologist	013802	NY

General Provider Information

NPI Number	:	1710123369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL JAY SAMET PH.D.

Provider Business Mailing Address
First Line	:	6 DOUGLAS DR
Second Line	:
City	:	SOUTH SALEM
State	:	NY
Zip	:	10590-2304
Country	:	US
Telephone Number	:	914-533-2532
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 GLENN ST
Second Line	:	SUITE 305
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-3254
Country	:	US
Telephone Number	:	914-980-0722
Fax Number	:

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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