Samantha Boruchov, MS.ED, PD, NCSP
Individual provider Active NPI School Psychologist · Bear, DE
NPI 1659801751 · NPPES record last updated Jun 13, 2017
Key facts
- NPI
- 1659801751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 86156 (DE)
- Practice address
- 925 Bear Corbitt Rd
Bear, DE 19701-1323 - Phone
- (302) 454-2720
- NPI assigned
- Jun 13, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86156 | DE | MD | School Psychologist |
| 2696901 | NY | MD | School Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 2696901 | NY | |
| School Psychologist | 103TS0200X | 86156 | DE | Yes |
Addresses
Primary practice location
925 Bear Corbitt Rd
Bear, DE 19701-1323
Mailing address
925 Bear Corbitt Rd
Bear, DE 19701-1323
Other providers in Bear, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.