Active NPI
Samantha Logan, PSYD
- Psychologist
- Wynnewood, PA
National Provider Identifier
1598430589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS019072
- Practice address
- 612 Fariston Dr
Wynnewood, PA 19096-2507 - Phone
- (609) 432-0672
- NPI assigned
- Aug 11, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS019072 | PA | Primary |
Addresses
Primary practice location
612 Fariston Dr
Wynnewood, PA 19096-2507
Mailing address
612 Fariston Dr
Wynnewood, PA 19096-2507
Phone (609) 432-0672
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 |
|---|---|---|---|
| PS019072 | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628640000000",
"number": "1598430589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 FARISTON DR",
"city": "WYNNEWOOD",
"state": "PA",
"postal_code": "190962507",
"telephone_number": "609-432-0672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 FARISTON DR",
"city": "WYNNEWOOD",
"state": "PA",
"postal_code": "190962507",
"telephone_number": "609-432-0672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "SAMANTHA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-11",
"last_updated": "2021-08-11",
"certification_date": "2021-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": "PA",
"license": "PS019072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wynnewood, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.