Individual provider Active NPI

Lonny Aaron Samuels, LCSW-C

  • Clinical Social Worker
  • Nottingham, MD
National Provider Identifier
1619151495
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11254 Issued in MD
Practice address
9021 Moonstone Rd
Nottingham, MD 21236-1923
Phone
(410) 804-5097
NPI assigned
Dec 28, 2007
Last updated
Dec 28, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 11254 MD Primary

Addresses

Primary practice location

9021 Moonstone Rd
Nottingham, MD 21236-1923

Mailing address

9021 Moonstone Rd
Nottingham, MD 21236-1923
Phone (410) 804-5097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081016000364 MD Practitioner - Clinical Social Worker 3779641980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Behavioral Health, LLCGroup PAC ID 3476777947, 62 clinicians

Practice addresses (Care Compare)

9627 Philadelphia Rd
Suite 160
Rosedale, MD 21237-4157
Phone (410) 780-5203

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11254MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Behavioral Health, LLC Current Accepting new patients
Thrive Behavioral Health, LLC CurrentSince Dec 1, 2020 Accepting new patients
Thrive Behavioral Health, LLC CurrentSince Dec 1, 2020 Accepting new patients
Family Matters Therapeutic Services, LLC Past Accepting new patients

Locations

1114 Benfield Blvd
Ste G
Millersville, MD 21108
Phone (410) 780-4320

9627 Philadelphia Rd
Ste 160
Rosedale, MD 21237
Phone (410) 780-5205

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1619151495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9021 MOONSTONE RD",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212361923",
            "telephone_number": "410-804-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9021 MOONSTONE RD",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212361923",
            "telephone_number": "410-804-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "LONNY",
        "middle_name": "AARON",
        "name_prefix": "Mr.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "11254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

Verify at the official NPI Registry.