Healthcare Provider Details

I. General information

NPI: 1316077795
Provider Name (Legal Business Name): RACHEL ANN SAMPSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WOODLAND DR
HARWINTON CT
06791-1303
US

IV. Provider business mailing address

21 WOODLAND DR
HARWINTON CT
06791-1303
US

V. Phone/Fax

Practice location:
  • Phone: 860-485-1459
  • Fax:
Mailing address:
  • Phone: 860-485-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number002212
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002212
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002212
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: