Samantha Marie Sorensen, PSY.D., LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP5556 Issued in MN

Practice address

4601 Excelsior Blvd Ste 411
St Louis Park, MN 55416-4977

Phone

(763) 614-5060

Fax

(763) 614-5060

NPI assigned

Nov 26, 2012

Sex

Female

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1353888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1750625166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12331 MARMON ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554496280",
            "telephone_number": "763-350-9032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 EXCELSIOR BLVD STE 411",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164977",
            "telephone_number": "763-614-5060",
            "fax_number": "763-614-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SORENSEN",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "credential": "PSY.D., LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-26",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP5556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Margaret Sonnenburg, CNM
• Paula W Sonsalla
• Tulsie Sookdeo, P.T., A.T.C
• Marjorie K Soper
• Christina Sorensen, DMD
• Shereen Sorensen, FNP, RN
• Susan J Sorensen, RD, CDE
• Paige E Sorenson, MSW, LICSW
• Kelli A Sorge, PA
• Emmeline Darice Soto

• Psychologist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.