Samuel Keith Vanderburg, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

107145 Issued in TX

Practice address

1109 N Cooper St
Arlington, TX 76011-5545

Phone

(817) 404-2207

NPI assigned

Aug 16, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660608000000",
    "number": "1043938152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 TANGLEWOOD DR",
            "city": "MABANK",
            "state": "TX",
            "postal_code": "751564148",
            "telephone_number": "903-603-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 N COOPER ST",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760115545",
            "telephone_number": "817-404-2207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Tanglewood Dr",
            "address_purpose": "LOCATION",
            "city": "Mabank",
            "state": "TX",
            "postal_code": "751564148",
            "country_code": "US",
            "telephone_number": "903-603-4003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERBURG",
        "first_name": "SAMUEL",
        "middle_name": "KEITH",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "107145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "samvansr@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "102 Tanglewood Dr",
            "city": "Mabank",
            "state": "TX",
            "country_code": "US",
            "postal_code": "751564148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Johann Vanbeest, D. C., MBA
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• Andrea Vandyke, PTA
• Vanguard Medreview Inc.
• Sarah Digison Vann, MSN, APRN-CNP, PMHNP
• Corey Charles Vanpelt
• Nelson Vargas Jr.

• Social Worker in Arlington, TX
• Providers in Arlington, TX by specialty
• Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.