Elizabeth Samuel, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11880-123 Issued in WI

Practice address

6442 City West Pkwy Ste 200
Eden Prairie, MN 55344-2809

Phone

(763) 318-2788

NPI assigned

Mar 18, 2024

Last updated

Aug 14, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Rogers Memorial Hospital Incorporated

  dba Rogers Behavioral Health

  • Psychiatric Hospital
  • Oconomowoc, WI
  • NPI 1053329581
  Medicare reassignment NPD
• Rogers Memorial Hospital Incorporated

  dba Rogers Behavioral Health

  • Clinic/Center
  • Eden Prairie, MN
  • NPI 1013420561
  NPD (past)

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1164281713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6442 CITY WEST PKWY STE 200",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6442 CITY WEST PKWY STE 200",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553442809",
            "telephone_number": "763-318-2788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "ELIZABETH",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "29063",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "11880-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Muna Kulaten Said
• Mariia Sakharova
• Katrina Mae Salo
• Jaime Kristin Salvatore, D.O.
• Wade Rix Samford
• Krista Emily Samuelson
• Nathaniel Saul Samuelson, DC
• Andres Roberto Sanchez, DDS
• Ingrid Sanchez, MA
• Ilyne Sandas, MALP

• Clinical Social Worker in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.