Samantha Pieknik, PSY.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

4913 Issued in AZ

Practice address

7330 N 16TH St Ste C-200
Phoenix, AZ 85020-5237

Phone

(480) 269-5803

NPI assigned

Jun 2, 2015

Sex

Female

Sole proprietor

Yes

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

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.

• Chehalem Youth and Family Services

  • Mental Illness Community Based Residential Treatment Facility
  • Newberg, OR
  • NPI 1982952958
  NPD (past)

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1366822652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7330 N 16TH ST STE C-200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850205237",
            "telephone_number": "480-269-5803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7330 N 16TH ST STE C-200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850205237",
            "telephone_number": "480-269-5803"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971322909",
            "country_code": "US",
            "telephone_number": "503-538-4874",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2345 E Thomas Rd Ste 200A",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850167818",
            "country_code": "US",
            "telephone_number": "480-849-9694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PIEKNIK",
        "first_name": "SAMANTHA",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-02",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "AZ",
            "license": "4913",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheyenne Pico
• Daniel Pico
• Piece of Mind Behavioral Health LLC
• Piece of Mind Transportation LLC
• Piece of the Puzzle Counseling & Wellness LLC
• Grazyna M Piekos-Sobczak, M.D.
• Valerie Ellen Pieraccini, OTR
• Aliece Pierce-Anderson, LPC
• Aimee Elizabeth Pierce, MD
• Ashley Pierce

• Clinical Child & Adolescent Psychologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Child & Adolescent Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.