Samantha Fortin, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801102790 Issued in MI

Practice address

13213 E 14 Mile Rd
Sterling Heights, MI 48312-6302

Phone

(586) 939-4374

Fax

(586) 939-4783

NPI assigned

Feb 17, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Samantha Cloutier Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1174914808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13213 E 14 MILE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483126302",
            "telephone_number": "586-939-4374",
            "fax_number": "586-939-4783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13213 E 14 MILE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483126302",
            "telephone_number": "586-939-4374",
            "fax_number": "586-939-4783"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Stoddard Rd",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "MI",
            "postal_code": "480622505",
            "country_code": "US",
            "telephone_number": "810-392-2167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTIN",
        "first_name": "SAMANTHA",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-17",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801102790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LLMSW LICENSE NUMBER",
            "identifier": "6801102790",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMSW LICENSE NUMBER",
            "identifier": "6801108455",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "CLOUTIER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Social Worker in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; 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.