Healthcare Provider Details

I. General information

NPI: 1669601977
Provider Name (Legal Business Name): SAMANTHA RACHEL KANE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 GODDARD PKWY
SALISBURY MD
21801-1126
US

IV. Provider business mailing address

2336 GODDARD PKWY
SALISBURY MD
21801-1126
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-6961
  • Fax: 410-334-6960
Mailing address:
  • Phone: 410-334-6961
  • Fax: 410-334-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04391
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: