Active NPI
Samantha Shay, LCSW
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1467164129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149024626
- Practice address
- 5425 W Lake St
Chicago, IL 60644-2342 - Phone
- (773) 378-3347
- Fax
- (773) 378-4028
- NPI assigned
- Dec 14, 2022
- Sex
- Female
- 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 Social Worker | 1041C0700X | 149024626 | IL | Primary |
Addresses
Primary practice location
5425 W Lake St
Chicago, IL 60644-2342
Mailing address
5425 W Lake St
Chicago, IL 60644-2342
Phone (773) 378-3347
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149024626 | Other | IL | PROFESSIONAL LICENSE NUMBER |
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 |
|---|---|---|---|
| 149024626 | IL | MD | Clinical Social Worker |
Interoperability endpoints
- samantha.shay.1@13158.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670976000000",
"number": "1467164129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5425 W LAKE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606442342",
"telephone_number": "773-378-3347",
"fax_number": "773-378-4028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5425 W LAKE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606442342",
"telephone_number": "773-378-3347",
"fax_number": "773-378-4028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAY",
"first_name": "SAMANTHA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-12-14",
"last_updated": "2022-12-14",
"certification_date": "2022-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149024626",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE NUMBER",
"identifier": "149024626",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.