Active NPI
Samuel Robert Stork, PSY.D
- Clinical Psychologist
- South Windsor, CT
National Provider Identifier
1295459485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 12453627-2501
- Practice address
- 18 Rockwell CT
South Windsor, CT 06074-6901 - Phone
- (860) 251-9816
- NPI assigned
- Sep 30, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 12453627-2501 | UT | Primary |
Addresses
Primary practice location
18 Rockwell CT
South Windsor, CT 06074-6901
Mailing address
18 Rockwell CT
South Windsor, CT 06074-6901
Phone (860) 251-9816
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12453627-2501 | UT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788220800000",
"number": "1295459485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 ROCKWELL CT",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060746901",
"telephone_number": "860-251-9816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 ROCKWELL CT",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060746901",
"telephone_number": "860-251-9816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STORK",
"first_name": "SAMUEL",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-30",
"last_updated": "2026-09-01",
"certification_date": "2026-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "12453627-2501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.