Myra Brunson-Samuel, MSW, LISW-CP
Individual provider Active NPI Clinical Social Worker · Greenville, SC
NPI 1013273572 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1013273572
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 11830 (SC)
- Practice address
- 3620 Pelham Rd Ste 252
Greenville, SC 29615-5044 - Phone
- (864) 381-7818
- NPI assigned
- Apr 9, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191231000315 | SC | Practitioner - Clinical Social Worker | 7012341969 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Step Forward Counseling Services LLC | Current |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IJFFBA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11830 | SC | Yes |
Addresses
Primary practice location
3620 Pelham Rd Ste 252
Greenville, SC 29615-5044
Mailing address
3620 Pelham Rd Ste 252
Greenville, SC 29615-5044
Phone (864) 381-7818
Other practice location 1
538 Marchbanks Rd
Boiling Springs, SC 29316-9302
Phone (864) 381-7818
Other providers in Greenville, SC
- Stephanie Carol Brundage
- Sydney Nicole Brunel
- Chauneci Amber Brunner
- Deborah A Brunner
- Callie Bruns
- Cicely Brunt
- Darryl Jon Brush
- Morgan Brush
- Jennette Ilene Bruster
- Alyssa Bryan
All providers in Greenville, SC · Clinical Social Worker in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.