Melissa Samples Kimberling, LCSW

Primary specialty

School Social WorkerTaxonomy code 1041S0200X

License

RO41152-1 Issued in NY

Practice address

24 Jameson CT
East Northport, NY 11731-1629

Phone

(631) 754-5431

NPI assigned

Sep 8, 2010

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

• Mrs. Melissa Samples Martinez Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• QC - Medi New York, Inc.

  • Home Health Agency
  • Riverhead, NY
  • NPI 1235458035
  NPD (past)

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

{
    "created_epoch": "1283904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1013224336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 JAMESON CT",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117311629",
            "telephone_number": "631-754-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 JAMESON CT",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117311629",
            "telephone_number": "631-754-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBERLING",
        "first_name": "MELISSA",
        "middle_name": "SAMPLES",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-08",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NY",
            "license": "RO41152-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "MARTINEZ",
            "middle_name": "SAMPLES",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexis Kelly
• Danielle Lynn Kennedy, RD
• Shakira Khan, BSC
• Inyoung Kim
• Michael Kim, L.AC.
• Stacy Ann Kinirons, PHD
• Devin James Klein, DDS
• Joseph Kleynowski, DPT
• Peter Michael Koblan III, DDS
• Jessica Marie Koenig

• School Social Worker in East Northport, NY
• Providers in East Northport, NY by specialty
• School Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.