Active NPI
Samantha Blackadar, LCSW, LICSW
- Clinical Social Worker
- South Portland, ME
National Provider Identifier
1164068128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LC18385
- Practice address
- 100 Gannett Dr
South Portland, ME 04106-5900 - Phone
- (207) 854-1030
- NPI assigned
- Nov 25, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC18385 | Primary |
Addresses
Primary practice location
100 Gannett Dr
South Portland, ME 04106-5900
Mailing address
46 Evans Road
Bridgton, ME 04009
Phone (603) 969-5317
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574640000000",
"number": "1164068128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 EVANS ROAD",
"city": "BRIDGTON",
"state": "ME",
"postal_code": "04009",
"telephone_number": "603-969-5317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 GANNETT DR",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041065900",
"telephone_number": "207-854-1030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKADAR",
"first_name": "SAMANTHA",
"credential": "LCSW, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-25",
"last_updated": "2019-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": "LC18385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.