Active NPI
Andrea L King, LSW
- Social Worker
- Dayton, OH
National Provider Identifier
1093135790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.0700733
- Practice address
- 601 S Edwin C Moses Blvd
Samaritan Behavioral Health, Inc.
Dayton, OH 45417-3424 - Phone
- (934) 734-8333
- Fax
- (937) 734-4343
- NPI assigned
- Apr 21, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.0700733 | OH | Primary |
Addresses
Primary practice location
601 S Edwin C Moses Blvd
Samaritan Behavioral Health, Inc.
Dayton, OH 45417-3424
Mailing address
601 S Edwin C Moses Blvd
Samaritan Behavioral Health, Inc.
Dayton, OH 45417-3424
Phone (934) 734-8333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.0700733 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samaritan Behavioral Health, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Dayton, OH
- NPI 1629022330
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412035200000",
"number": "1093135790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 S EDWIN C MOSES BLVD",
"address_2": "SAMARITAN BEHAVIORAL HEALTH, INC.",
"city": "DAYTON",
"state": "OH",
"postal_code": "454173424",
"telephone_number": "934-734-8333",
"fax_number": "937-734-4343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 S EDWIN C MOSES BLVD",
"address_2": "SAMARITAN BEHAVIORAL HEALTH, INC.",
"city": "DAYTON",
"state": "OH",
"postal_code": "454173424",
"telephone_number": "934-734-8333",
"fax_number": "937-734-4343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "ANDREA",
"middle_name": "L",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-21",
"last_updated": "2014-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.0700733",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
- Kindred Connections Therapy Center
- Kindred Hospital
- Kindred Hospitals East, LLC (Kindred Hospital - Dayton)
- Kindred Hospitals East, LLC (Kindred Hospital - Dayton (Behavioral Health Unit))
- King Tree Leasing Co., LLC (Riverside Healthcare Center)
- Andrea Lynn King, PA-C
- Antonio King Jr., LSATP
- Beverly R King, O.T.
- Brianna Marie King, MS, RDN, LD
- Carla Renee King, CNM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.