Active NPI
Samuel Hackworth, PH.D.
- Clinical Child & Adolescent Psychologist
- Austin, TX
National Provider Identifier
1194928317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 31411
- Practice address
- 4601 Spicewood Springs Rd
#4-200
Austin, TX 78759-8598 - Phone
- (512) 467-1376
- NPI assigned
- Jun 6, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 31411 | TX | Primary |
Addresses
Primary practice location
4601 Spicewood Springs Rd
#4-200
Austin, TX 78759-8598
Mailing address
4601 Spicewood Springs Rd
#4-200
Austin, TX 78759-8598
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31411 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194928317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 SPICEWOOD SPRINGS RD",
"address_2": "#4-200",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787598598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 SPICEWOOD SPRINGS RD",
"address_2": "#4-200",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787598598",
"telephone_number": "512-467-1376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKWORTH",
"first_name": "SAMUEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "TX",
"license": "31411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.