Samuel A Bastien IV, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

009639-01 Issued in NY

Practice address

135 S Broadway
Saratoga Springs, NY 12866-4532

Phone

(518) 584-9030

Fax

(518) 581-1709

NPI assigned

Jun 23, 2021

Last updated

Jun 23, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Four Winds - Saratoga Out-Patient Psychiatric Service, P.C.

  • Psychologist
  • Saratoga Springs, NY
  • NPI 1336146901
  NPD

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1609445766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4061 FLINT CT",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120202598",
            "telephone_number": "315-261-9862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 S BROADWAY",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "128664532",
            "telephone_number": "518-584-9030",
            "fax_number": "518-581-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIEN",
        "first_name": "SAMUEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "009639-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Lee Barraclough, ANP-BC
• Jamal Charles Barrow
• Barry O. Maisel, MD
• Laura Bartels-Peculis, PHARM.D., R.PH.
• Alexis Bartocci, NP
• Kimberly Ann Bauer
• Robert Bauer, LCSW
• Bay Optical, Inc
• Jennifer Bayron, M.D.
• Jaid Baytos

• Clinical Psychologist in Saratoga Springs, NY
• Providers in Saratoga Springs, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.

Verify at the official NPI Registry.