Samantha Dewitt Wilson, PSYD, LCSW

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY34430 Issued in CA

Practice address

10085 Carroll Canyon Rd Ste 200H
San Diego, CA 92131-1100

Phone

(858) 208-3463

NPI assigned

Jul 9, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

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.

Enrollment records 2

Specialty

Clinical Psychologist

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Adr Wellness a Professional Psychology CorporationGroup PAC ID 1456764216, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Adr Wellness a Professional Psychology Corporation

  • Psychiatry Physician
  • Carlsbad, CA
  • NPI 1073028742

  Psychologist

  Medicare reassignment Care Compare group NPD
• Neuroevolve Integrative Health, a Professional Psychology Corporation

  • Clinical Neuropsychologist
  • San Diego, CA
  • NPI 1588406177
  NPD Authorized official

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1881823045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10085 CARROLL CANYON RD STE 200H",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311100",
            "telephone_number": "858-208-3463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10085 CARROLL CANYON RD STE 200H",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311100",
            "telephone_number": "858-208-3463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "785 Grand Ave Ste 212",
            "address_purpose": "LOCATION",
            "city": "Carlsbad",
            "state": "CA",
            "postal_code": "920082371",
            "country_code": "US",
            "telephone_number": "760-453-7175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SAMANTHA",
        "middle_name": "DEWITT",
        "name_prefix": "Dr.",
        "credential": "PSYD, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-09",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "34430",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "76389",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY34430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quinn D Wilson, MS
• Randall Glenn Wilson, PSY.D.
• Richard Kenny Wilson, DDS
• Rosa L Wilson
• Rosalie Brooke Wilson, LPCC
• Sandra Kay Wilson
• Saundra Lynn Wilson
• Savannah Nicole Wilson
• Sha'Rika Wilson, LMSW
• Shannon Elise Wilson

• Clinical Neuropsychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.