Provider Demographics
NPI:1871992578
Name:WERTHEIMER, SAMANTHA ROBIN (PSYD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ROBIN
Last Name:WERTHEIMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 ASH LANE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-9626
Mailing Address - Country:US
Mailing Address - Phone:215-792-2323
Mailing Address - Fax:
Practice Address - Street 1:1202 ASH LANE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-9626
Practice Address - Country:US
Practice Address - Phone:215-792-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PS019119103TF0000X, 103TC2200X
PAPS019119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent