Samantha Gwen Lee, LMSW, LASAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

16048 Issued in AZ

Practice address

Corner of Route N12 and N7
Fort Defiance, AZ 86504

Phone

(928) 729-8000

NPI assigned

Mar 4, 2008

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

Medicare fee-for-service enrollment

Enrolled in TX

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Fort Defiance Indian Hospital Board, Incorporation

  • General Acute Care Hospital
  • Fort Defiance, AZ
  • NPI 1477876639

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475452800000",
    "number": "1396915542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 589",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040589",
            "telephone_number": "928-729-8500",
            "fax_number": "928-729-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTE N12 AND N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "SAMANTHA",
        "middle_name": "GWEN",
        "name_prefix": "Ms.",
        "credential": "LMSW, LASAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-04",
        "last_updated": "2016-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AZ",
            "license": "13084",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "11643",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "16048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Logan Howard Daniel Latvis, PTA
• Nicholas Dehner Laughton, PHARMD, MPH
• Alan Lazzar
• Nghiem Thanh Le, DDS
• Robin Cuong Le, D.D.S.
• Macy Lehotay, RN
• James Leslie, LSAA
• Lynn Alane Leslie, RCP-RRT
• Micah Gene-Lauren Leslie, RDH
• Melissa Marie Lester, O.D.

• Clinical Social Worker in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; 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.