Healthcare Provider Details

I. General information

NPI: 1487172987
Provider Name (Legal Business Name): SAMANTHA NICOLE RIVAS MORGAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA NICOLE RIVAS PSY.D.

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1222
US

IV. Provider business mailing address

1950 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1222
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-3571
  • Fax:
Mailing address:
  • Phone: 650-573-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5564-57
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4199
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: