Samuel Mark Brotkin, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

3500 Westgate Dr Ste 900
Durham, NC 27707-2534

Phone

(516) 880-4536

NPI assigned

Sep 19, 2024

Sex

Male

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

Credentials

Doctor of Philosophy

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.

• Anna Elizabeth Craig PHD Clinical Psychologist

  • Adolescent and Children Mental Health Clinic/Center
  • Durham, NC
  • NPI 1316643950
  NPD (past)

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

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1538996830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 WESTGATE DR STE 900",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 WESTGATE DR STE 900",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072534",
            "telephone_number": "516-880-4536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTKIN",
        "first_name": "SAMUEL",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-19",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810008519",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor M Broome, MD
• Alisha B. Brosse, PH.D
• Kyla Morgan Brossoit
• Jenna Nicole Brothers, PA-C
• Elana Jaffe Brotkin, MD, MPH
• Erin P Broush, NNP-BC
• Shea Denise Broussard, M.A.
• Angelica Jade Brower, MA
• Stacey Erin Brower, PA-C
• Donald E Browm

• Clinical Child & Adolescent Psychologist in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Child & Adolescent Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.