Kibasa Samuel, LCSW, CASAC, SAP MAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

090232 Issued in NY

Practice address

169 Commack Rd # 1010
Commack, NY 11725-3442

Phone

(516) 430-7372

NPI assigned

Oct 12, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1407227879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 COMMACK RD # 1010",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253442",
            "telephone_number": "516-430-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 COMMACK RD # 1010",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253442",
            "telephone_number": "516-430-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "KIBASA",
        "name_prefix": "Ms.",
        "credential": "LCSW, CASAC, SAP MAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-12",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "31589",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NY",
            "license": "4937560",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "72091813",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "090232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Martha Sakowitz, FNP-C
• Lisa R Salinger, PT
• Danyel Salpietro, PSY D
• Robert Salpietro Jr., LMSW
• Same Day Smiles of Commack
• Jacqueline Sanders, M.S
• Melissa Sandezer
• Joseph Thomas Sanelli, D.O.
• Christina Lynne Santa Maria, M.S.P.T.
• Laura Santiago

• Clinical Social Worker in Commack, NY
• Providers in Commack, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.