Active NPI
Tracy Samuel, LCSW-C, LICSW
- Clinical Social Worker
- Takoma Park, MD
National Provider Identifier
1598076937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 13543
- Practice address
- 7000 Carroll Ave
Suite 200
Takoma Park, MD 20912-4437 - Phone
- (240) 381-9705
- NPI assigned
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | 13543 | MD | Primary |
Addresses
Primary practice location
7000 Carroll Ave
Suite 200
Takoma Park, MD 20912-4437
Mailing address
7000 Carroll Ave
Suite 200
Takoma Park, MD 20912-4437
Phone (240) 381-9705
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13543 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294099200000",
"number": "1598076937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7000 CARROLL AVE",
"address_2": "SUITE 200",
"city": "TAKOMA PARK",
"state": "MD",
"postal_code": "209124437",
"telephone_number": "240-381-9705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7000 CARROLL AVE",
"address_2": "SUITE 200",
"city": "TAKOMA PARK",
"state": "MD",
"postal_code": "209124437",
"telephone_number": "240-381-9705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "TRACY",
"credential": "LCSW-C, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-30",
"last_updated": "2011-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "13543",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Takoma Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.