Active NPI
Samantha Mann, PSY.D.
- Clinical Psychologist
- Boulder, CO
National Provider Identifier
1629510649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY.0004481
- Practice address
- 255 Canyon Blvd
Suite 200
Boulder, CO 80302-4979 - Phone
- (303) 474-4055
- Fax
- (720) 638-3699
- NPI assigned
- Nov 8, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | PSY.0004481 | CO | |
| Clinical Psychologist | 103TC0700X | PSY.0004481 | CO | Primary |
Addresses
Primary practice location
255 Canyon Blvd
Suite 200
Boulder, CO 80302-4979
Mailing address
255 Canyon Blvd
Suite 200
Boulder, CO 80302-4979
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY.0004481 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515974400000",
"number": "1629510649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 CANYON BLVD",
"address_2": "SUITE 200",
"city": "BOULDER",
"state": "CO",
"postal_code": "803024979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 CANYON BLVD",
"address_2": "SUITE 200",
"city": "BOULDER",
"state": "CO",
"postal_code": "803024979",
"telephone_number": "303-474-4055",
"fax_number": "720-638-3699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANN",
"first_name": "SAMANTHA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-08",
"last_updated": "2018-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CO",
"license": "PSY.0004481",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "PSY.0004481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.