Healthcare Provider Details

I. General information

NPI: 1710311873
Provider Name (Legal Business Name): NAOMI SAMIMI-SADEH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NAOMI SADEH

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CAROLINA AVE
JAMAICA PLAIN MA
02130-3247
US

IV. Provider business mailing address

131 CAROLINA AVE
JAMAICA PLAIN MA
02130-3247
US

V. Phone/Fax

Practice location:
  • Phone: 608-698-2216
  • Fax:
Mailing address:
  • Phone: 608-698-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS01366
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS01366
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0001110
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: