Active NPI
Ericka Sam, LCSW
- Clinical Social Worker
- Crestview, FL
National Provider Identifier
1366719130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW 10591
- Practice address
- 259 E Oakdale Ave
Crestview, FL 32539-3547 - Phone
- (850) 682-1234
- Fax
- (850) 689-8799
- NPI assigned
- Nov 22, 2011
- 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 | SW 10591 | FL | Primary |
Addresses
Primary practice location
259 E Oakdale Ave
Crestview, FL 32539-3547
Mailing address
259 E Oakdale Ave
Crestview, FL 32539-3547
Phone (850) 682-1234
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW 10591 | FL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nursing Home Psychological Services of FL LLC | Clinical | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Psychologist
- Destin, FL
- NPI 1750673950
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321920000000",
"number": "1366719130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 E OAKDALE AVE",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325393547",
"telephone_number": "850-682-1234",
"fax_number": "850-689-8799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "259 E OAKDALE AVE",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325393547",
"telephone_number": "850-682-1234",
"fax_number": "850-689-8799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "ERICKA",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-22",
"last_updated": "2011-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW 10591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
- Sacred Heart Medical Group
- Safe and Secure Respite Care, LLC (Carington Manor)
- Safe and Secure Respite Care, LLC (Carington Manor)
- Sage Wellness Birth Collaborative
- Candice Mi Salis
- Rayanne Phelps Sanders, LCSW
- Santa Rosa HB Medical Services LLC
- Lindsay Ann Santos, ARNP
- Ruth Elina Sarit
- Christine Marie Sass, MPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.