Samantha Alexis King, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

09926136 Issued in CO

Practice address

636 NE Bernard St
Jensen Beach, FL 34957-6164

Phone

(772) 485-6301

NPI assigned

Mar 28, 2017

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Tides Changing Therapy

  • Clinical Social Worker
  • Denver, CO
  • NPI 1891396693
  NPD

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680825600000",
    "number": "1477085736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 NE BERNARD ST",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349576164",
            "telephone_number": "772-485-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 NE BERNARD ST",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349576164",
            "telephone_number": "772-485-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "SAMANTHA",
        "middle_name": "ALEXIS",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "09926136",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "11020",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "16399",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Peterman
• Shauna Kelly
• Kathleen Crystal Kelsay
• Christopher W. Kindig, D.M.D.
• Nancy E King, LCSW
• Megan Kissane, BS
• Ellen Margo Klein-South, M.S.
• Krista Klosowski, RN, LDN, CNS
• Kneaded Escape Massage LLC
• Allison Knecht

• Clinical Social Worker in Jensen Beach, FL
• Providers in Jensen Beach, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; 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.