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General NPI Number Information
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NPI Number | 1790092229
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Entity Type | Individual
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Provider Name | SAMANTHA NAOMI ORBACH PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 01/12/2019
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Provider Practice Location Address
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Address Line | 70 E LAKE ST STE 1300
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City | CHICAGO
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State | IL
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Zip | 60601-7458
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Country | US
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Telephone | 847-370-7264
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Fax |
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Provider Business Mailing Address
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Address Line | 2743 N WOLCOTT AVE UNIT 46
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City | CHICAGO
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State | IL
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Zip | 60614-1067
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Country | US
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Telephone | 847-370-7264
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008771
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License Number State | IL
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