Healthcare Provider Details

I. General information

NPI: 1912819418
Provider Name (Legal Business Name): SAMANTHA DORIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 HARVARD ST STE 3A
BROOKLINE MA
02446-6439
US

IV. Provider business mailing address

124 HARVARD ST STE 3A
BROOKLINE MA
02446-6439
US

V. Phone/Fax

Practice location:
  • Phone: 617-501-2715
  • Fax:
Mailing address:
  • Phone: 617-501-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: