NPIMap

Organization Active NPI

Samuel T Bolin Jr LCSW-C, LLC

  • Clinical Social Worker
  • Linthicum, MD
National Provider Identifier
1578091583
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
20697 Issued in MD
Legal business name
SAMUEL T BOLIN JR LCSW-C, LLC
Practice address
939 Elkridge Landing Rd Ste 350
Linthicum, MD 21090-2909
Phone
(443) 588-8753
NPI assigned
Jun 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Authorized official

Name
Mr. Samuel Todd Bolin Jr., LCSW-CNPI 1598175648
Title
Owner
Phone
(443) 310-0466

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 20697 MD Primary

Addresses

Primary practice location

939 Elkridge Landing Rd Ste 350
Linthicum, MD 21090-2909

Mailing address

1013 Bluebells Rd
Gambrills, MD 21054-2059
Phone (443) 310-0466

Other practice location 1

518 S Camp Meade Rd Ste 4
Linthicum, MD 21090-2766
Phone (443) 588-8753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170706000090 MD Part B Supplier - Clinic/Group Practice 7810266939 Receives reassigned benefits from 1 practitioner
Practice locations: Linthicum, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1496448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636675200000",
    "number": "1578091583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 BLUEBELLS RD",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210542059",
            "telephone_number": "443-310-0466",
            "fax_number": "443-231-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 ELKRIDGE LANDING RD STE 350",
            "city": "LINTHICUM",
            "state": "MD",
            "postal_code": "210902909",
            "telephone_number": "443-588-8753"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "518 S Camp Meade Rd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Linthicum",
            "state": "MD",
            "postal_code": "210902766",
            "country_code": "US",
            "telephone_number": "443-588-8753",
            "fax_number": "443-231-4331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAMUEL T BOLIN JR LCSW-C, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-03",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A",
        "authorized_official_last_name": "BOLIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-310-0466",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "20697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Linthicum, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.