Healthcare Provider Details

I. General information

NPI: 1558255885
Provider Name (Legal Business Name): SAMANTHA KATE SOMMER LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3728 LEWIS AVE
LONG BEACH CA
90807-4120
US

IV. Provider business mailing address

3728 LEWIS AVE
LONG BEACH CA
90807-4120
US

V. Phone/Fax

Practice location:
  • Phone: 914-721-3007
  • Fax:
Mailing address:
  • Phone: 914-721-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4523
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: