Kevin Garner Sample, LCSW, LADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC15430 Issued in ME

Practice address

Eastport Health Care
30 Boynton Street
Eastport, ME 04631

Phone

(207) 853-0185

Fax

(207) 853-4248

NPI assigned

Jul 18, 2013

Last updated

Jul 1, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1374105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561939200000",
    "number": "1740622836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 630",
            "city": "CALAIS",
            "state": "ME",
            "postal_code": "046190630",
            "telephone_number": "207-751-8712",
            "fax_number": "207-454-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "EASTPORT HEALTH CARE",
            "address_2": "30 BOYNTON STREET",
            "city": "EASTPORT",
            "state": "ME",
            "postal_code": "04631",
            "telephone_number": "207-853-0185",
            "fax_number": "207-853-4248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "KEVIN",
        "middle_name": "GARNER",
        "credential": "LCSW, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-18",
        "last_updated": "2019-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC15430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010276859",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Eastport, ME
• Providers in Eastport, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2019; 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.