Mallory C Sample, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2012007447 Issued in MO

Practice address

4485 Westminster PL
Saint Louis, MO 63108-1812

Phone

(314) 535-7911

NPI assigned

Apr 30, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1679831549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5609 DEVONSHIRE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631092872",
            "telephone_number": "314-494-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4485 WESTMINSTER PL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081812",
            "telephone_number": "314-535-7911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "MALLORY",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-30",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2012007447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samone's Care LLC
• Samones Courier&Transport Services
• Andres Samos
• Hanish Sampath Kumar
• Kruthika Sampathgiri, MD
• Theodore G. Sample Jr., M.D.
• Adam Robert Sampson, PA
• Dawn R Sampson, MS, CCC/SLP
• Monisha K Sampson
• Sams East Inc (Sams Pharmacy 10-8205)

• Clinical Social Worker in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; 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.