Provider Demographics
NPI:1982363487
Name:BERNECKER, SAMANTHA LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:BERNECKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:BERNECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2838 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6102
Mailing Address - Country:US
Mailing Address - Phone:814-574-9625
Mailing Address - Fax:
Practice Address - Street 1:2838 30TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6102
Practice Address - Country:US
Practice Address - Phone:814-574-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61190950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical