Active NPI
Ignatius A Samuel, LCSW
- Clinical Social Worker
- Dayville, CT
National Provider Identifier
1861636631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW00579
- Practice address
- 1007 N Main St
Dayville, CT 06241-2170 - Phone
- (860) 774-2020
- Fax
- (860) 774-0095
- NPI assigned
- Apr 23, 2009
- Sex
- Male
- Sole proprietor
- No
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 | CSW00579 | RI | Primary |
Addresses
Primary practice location
1007 N Main St
Dayville, CT 06241-2170
Mailing address
157 Dover St
Providence, RI 02908-3931
Phone (401) 274-0881
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW00579 | RI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240444800000",
"number": "1861636631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "157 DOVER ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029083931",
"telephone_number": "401-274-0881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1007 N MAIN ST",
"city": "DAYVILLE",
"state": "CT",
"postal_code": "062412170",
"telephone_number": "860-774-2020",
"fax_number": "860-774-0095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "IGNATIUS",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-23",
"last_updated": "2009-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "RI",
"license": "CSW00579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.