Healthcare Provider Details

I. General information

NPI: 1346128162
Provider Name (Legal Business Name): DYMOND SAMANTHA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 BURNET AVE
CINCINNATI OH
45219-2426
US

IV. Provider business mailing address

739 E MCMILLAN ST UNIT 1208
CINCINNATI OH
45206-3058
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5857
  • Fax:
Mailing address:
  • Phone: 516-451-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: