Samantha Brustad, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY10363 Issued in FL

Practice address

9887 4TH St N Ste 319
Saint Petersburg, FL 33702-8445

Phone

(727) 379-2807

NPI assigned

Dec 4, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Teletherapy Solutions LLC

  • Counselor
  • Saint Petersburg, FL
  • NPI 1558982264
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1013554435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9887 4TH ST N STE 319",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337028445",
            "telephone_number": "727-379-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9887 4TH ST N STE 319",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337028445",
            "telephone_number": "727-379-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSTAD",
        "first_name": "SAMANTHA",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-04",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY10363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaley Brunner, APRN
• Michael Anthony Bruno, MD
• Adam A Brunson, M.D.
• John C Brunson Jr., MD
• Brush Transport LLC
• Lillie Shanell Bruton, ARNP
• Jessica Schletter Bruzzichesi, PA-C
• Foster Curtis Bryan, M.D.
• Andrew G Bryant, OTA
• Christian Bryant

• Clinical Psychologist in Saint Petersburg, FL
• Providers in Saint Petersburg, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.