Individual provider Active NPI

Samantha Lizotte, LCSW

  • Clinical Social Worker
  • Wallingford, CT
National Provider Identifier
1073193116
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11450 Issued in CT
Practice address
45 Fair St
Wallingford, CT 06492-4208
Phone
(860) 455-8517
NPI assigned
Apr 13, 2021
Last updated
Feb 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 11450 CT Primary

Addresses

Primary practice location

45 Fair St
Wallingford, CT 06492-4208

Mailing address

45 Fair St
Wallingford, CT 06492-4208
Phone (860) 455-8517

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210427000430 CT Practitioner - Clinical Social Worker 0143638411 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

45 Fair St
Wallingford, CT 06492-4208
Phone (860) 901-7916

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11450CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
United Community and Family Services, Inc. CurrentSince Apr 12, 2021 Accepting new patients
United Community and Family Services, Inc. CurrentSince Apr 12, 2021 Accepting new patients
Balanced Life Counseling LLC Clinical CurrentSince Aug 10, 2023 Accepting new patients

Locations

70 Main St
Jewett City, CT 06351
Phone (860) 376-7040

2079 Killingly Commons Dr
Killingly, CT 06241

47 Town St
Norwich, CT 06360

45 Fair St
Wallingford, CT 06492
Phone (203) 565-5403

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1618272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1073193116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 FAIR ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064924208",
            "telephone_number": "860-455-8517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 FAIR ST",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064924208",
            "telephone_number": "860-455-8517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIZOTTE",
        "first_name": "SAMANTHA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-13",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "11450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

Verify at the official NPI Registry.