Samuel Lustgarten PHD LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SAMUEL LUSTGARTEN PHD LLC

Practice address

702 N Blackhawk Ave Ste 205
Madison, WI 53705-3357

Phone

(720) 260-4362

Fax

(971) 999-0817

NPI assigned

Sep 22, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Samuel David Lustgarten, PHDNPI 1477197929

Title

Licensed Psychologist/Owner

Phone

(720) 260-4362

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel David Lustgarten, PHD

  • Counseling Psychologist
  • Madison, WI
  • NPI 1477197929
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671753600000",
    "number": "1427729227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 N BLACKHAWK AVE STE 205",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537053357",
            "telephone_number": "720-260-4362",
            "fax_number": "971-999-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 N BLACKHAWK AVE STE 205",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537053357",
            "telephone_number": "720-260-4362",
            "fax_number": "971-999-0817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL LUSTGARTEN PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-22",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A",
        "authorized_official_last_name": "LUSTGARTEN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "720-260-4362",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sammy Care LLC
• Olivia Samoray
• Katherine Cook Sampene, M.D.
• Katherine S Sample, M.D.
• Blake Samsill
• Adam James Samuel, PA-C
• Allison Samuel, PHARMD
• Ashlin Samuel
• Chijioke Akam Samuel
• Kassandra Marie Sakura Samuel

• Mental Health Clinic/Center (Including Community Mental Health Center) in Madison, WI
• Providers in Madison, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.