Ajit Anant Samudra, MS, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

166000472 Issued in IL

Practice address

820 Davis St Ste 455
Evanston, IL 60201-4447

Phone

(224) 714-2412

NPI assigned

Mar 31, 2007

Last updated

May 10, 2022By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Core - Center of Relational Empowerment, PC

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1912270687
  NPD (past)

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

{
    "created_epoch": "1175299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1689794687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 DAVIS ST STE 455",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014447",
            "telephone_number": "224-714-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 DAVIS ST STE 455",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014447",
            "telephone_number": "224-714-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUDRA",
        "first_name": "AJIT",
        "middle_name": "ANANT",
        "name_prefix": "Mr.",
        "credential": "MS, LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-31",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166000472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sam's Club Optical (Sam's Club Optical 30-6444)
• Guinevere G Sammartino, FNP-C
• Karlie S Sample, MD
• Sams West Inc (Sams Pharmacy)
• Mary Susan Sams, PSY.D.
• Maya Mary Samuel
• Arnold C. Samuels, M.D.
• Mark Steven Samuelson, L.C.S.W.
• Thriveni Sanagala, MD
• Susan Virginia Sances, PSY.D.

• Marriage & Family Therapist in Evanston, IL
• Providers in Evanston, IL by specialty
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; 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.