MEDICARE: DR. SAMANTHA KALILIKANE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	11802	FL
2	103T00000X	Psychologist	11802	FL
3	103TC0700X	Clinical Psychologist	PSY-005852	AZ
4	103T00000X	Psychologist	PSY-005852	AZ

General Provider Information

NPI Number	:	1427752476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA KALILIKANE PSY.D.

Provider Business Mailing Address
First Line	:	9221 E BASELINE RD STE 109-248
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-8310
Country	:	US
Telephone Number	:	808-428-5199
Fax Number	:

Provider Business Practice Location Address
First Line	:	9221 E BASELINE RD STE 109-248
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-8310
Country	:	US
Telephone Number	:	727-416-1642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	04/06/2026

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