Active NPI
Samantha T Bender, PH.D.
- Clinical Psychologist
- Bethesda, MD
National Provider Identifier
1770529109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 03615
- Practice address
- 4915 Auburn Ave
Suite 110
Bethesda, MD 20814-2636 - Phone
- (301) 718-2971
- Fax
- (301) 718-2972
- NPI assigned
- Jun 22, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 03615 | MD | Primary |
Addresses
Primary practice location
4915 Auburn Ave
Suite 110
Bethesda, MD 20814-2636
Mailing address
4915 Auburn Ave
Suite 110
Bethesda, MD 20814-2636
Phone (301) 718-2971
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 400939800 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2021 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03615 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770529109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4915 AUBURN AVE",
"address_2": "SUITE 110",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208142636",
"telephone_number": "301-718-2971",
"fax_number": "301-718-2972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4915 AUBURN AVE",
"address_2": "SUITE 110",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208142636",
"telephone_number": "301-718-2971",
"fax_number": "301-718-2972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENDER",
"first_name": "SAMANTHA",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "03615",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "400939800",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.