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NPI Code Detail

MEDICARE: SAMANTHA PODSTUPKA THERAPY

MEDICARE: SAMANTHA PODSTUPKA THERAPY
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1851081319
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMANTHA PODSTUPKA THERAPY
Provider Business Mailing Address
First Line : 4055 INCA ST APT 318
Second Line :
City : DENVER
State : CO
Zip : 80211-2680
Country : US
Telephone Number : 310-905-2905
Fax Number :
Provider Business Practice Location Address
First Line : 4055 INCA ST APT 318
Second Line :
City : DENVER
State : CO
Zip : 80211-2680
Country : US
Telephone Number : 310-905-2905
Fax Number :
Authorized Official
Title or Position : LICENSED PSYCHOTHERAPIST
Name : SAMANTHA ASHLEY SEGALL
Credential :
Telephone Number : 415-634-7331
Provider Enumeration Date : 05/09/2023
Last Update Date : 05/09/2023

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