Individual provider Active NPI

Pamela Ruth Smith, M.S.W.

  • Clinical Social Worker
  • Phoenix, AZ
National Provider Identifier
1831242296
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
11144 Issued in LA
Practice address
4700 N 16TH St Apt 120
Phoenix, AZ 85016-4450
Phone
(225) 953-1923
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904015785 VA
Clinical Social Worker 1041C0700X 107664 TX
Clinical Social Worker 1041C0700X LCSW2353 AZ
Clinical Social Worker 1041C0700X 11144 LA Primary

Addresses

Primary practice location

4700 N 16TH St Apt 120
Phoenix, AZ 85016-4450

Mailing address

4700 N 16TH St Apt 120
Phoenix, AZ 85016-4450
Phone (225) 953-1923

Other identifiers 1

IdentifierTypeStateIssuer
749814OtherAZAHCCCS PROVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20250131001843 AZ Practitioner - Clinical Social Worker 2163951369 Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW2353AZMDClinical Social Worker
107664TXMDClinical Social Worker
0904015785VAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1831242296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 N 16TH ST APT 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164450",
            "telephone_number": "225-953-1923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 N 16TH ST APT 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164450",
            "telephone_number": "225-953-1923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PAMELA",
        "middle_name": "RUTH",
        "name_prefix": "Mrs.",
        "credential": "M.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904015785",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "107664",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW2353",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "11144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER ID",
            "identifier": "749814",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.