Healthcare Provider Details

I. General information

NPI: 1427752476
Provider Name (Legal Business Name): SAMANTHA KALILIKANE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 E BASELINE RD STE 109-248
MESA AZ
85209-8310
US

IV. Provider business mailing address

9221 E BASELINE RD STE 109-248
MESA AZ
85209-8310
US

V. Phone/Fax

Practice location:
  • Phone: 727-416-1642
  • Fax:
Mailing address:
  • Phone: 808-428-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number11802
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-005852
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11802
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005852
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: