Active NPI
Samantha Lynn Dorum, MS, BCBA
- Behavior Analyst
- Alameda, CA
National Provider Identifier
1477121978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BACB500114
- Practice address
- 1025 Atlantic Ave Ste 101
Alameda, CA 94501-1188 - Phone
- (510) 268-8120
- NPI assigned
- Jun 12, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BACB500114 | WA | Primary |
Addresses
Primary practice location
1025 Atlantic Ave Ste 101
Alameda, CA 94501-1188
Mailing address
4601 79TH Avenue CT W
University Place, WA 98466-3037
Phone (253) 298-7295
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB500114 | WA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623456000000",
"number": "1477121978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 79TH AVENUE CT W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984663037",
"telephone_number": "253-298-7295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 ATLANTIC AVE STE 101",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945011188",
"telephone_number": "510-268-8120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORUM",
"first_name": "SAMANTHA",
"middle_name": "LYNN",
"credential": "MS, BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-12",
"last_updated": "2021-06-12",
"certification_date": "2021-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WA",
"license": "BACB500114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.