Samantha Lynne Bernecker, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY61190950 Issued in WA

Practice address

2838 30TH Ave S
Seattle, WA 98144-6102

Phone

(814) 574-9625

NPI assigned

Dec 12, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Sam Bernecker Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1639267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639267200000",
    "number": "1982363487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2838 30TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981446102",
            "telephone_number": "814-574-9625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2838 30TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981446102",
            "telephone_number": "814-574-9625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNECKER",
        "first_name": "SAMANTHA",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-12",
        "last_updated": "2021-12-12",
        "certification_date": "2021-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61190950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAM",
            "last_name": "BERNECKER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Erin B Bernau
• Kyle Leland Bernbach
• Candace Lyn Bernd, MA CCC-SLP
• Daniel Scott Berndt
• Jennifer Edith Berndt
• Lynsey Michelle Eider Bernfeld, MD
• Jeremia Douglas Bernhardt, MD
• Linda Bernhardt
• Michael Hawthorne Berni, MED
• Raphael A Bernier, PHD

• Clinical Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2021; 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.