MEDICARE: SAMANTHA BOTH MS

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	PY13099	FL

General Provider Information

NPI Number	:	1770264921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BOTH MS

Provider Business Mailing Address
First Line	:	115 NE 3RD AVE APT 411
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 NE 3RD AVE APT 411
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1298
Country	:	US
Telephone Number	:	609-915-7998
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	01/07/2026

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Directions to “ SAMANTHA BOTH MS” Practice Location

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