Healthcare Provider Details

I. General information

NPI: 1578871851
Provider Name (Legal Business Name): SAMANTHA MCBRIDE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA SIMON

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 N REVERE CT
AURORA CO
80045-7464
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0004107
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0004107
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: