Individual
DR. SAMANTHA LYN BOUTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
430 SILLS RD, YAPHANK, NY 11980
(631) 924-5583
Mailing address
430 SILLS RD, YAPHANK, NY 11980
(631) 924-5583
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
297457
NY
Other
Enumeration date
04/24/2009
Last updated
09/08/2010
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