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General NPI Number Information
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NPI Number | 1710123369
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Entity Type | Individual
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Provider Name | MITCHELL JAY SAMET PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 30 GLENN ST SUITE 305
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City | WHITE PLAINS
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State | NY
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Zip | 10603-3254
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Country | US
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Telephone | 914-980-0722
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Fax |
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Provider Business Mailing Address
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Address Line | 6 DOUGLAS DR
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City | SOUTH SALEM
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State | NY
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Zip | 10590-2304
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Country | US
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Telephone | 914-533-2532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 013802
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License Number State | NY
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