Individual
SAMANTHA BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
160 W 86TH ST, NEW YORK, NY 10024-4018
(212) 362-8755
Mailing address
175 W 95TH ST APT 24D, NEW YORK, NY 10025-7166
(347) 996-9257
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
08/08/2020
Last updated
08/08/2020
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