Active NPI
Gwendolyn Phillips-Samuels
- Social Worker
- Miami, FL
National Provider Identifier
1881735355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 753154100
- Practice address
- 1601 NW 12TH Ave
Miami, FL 33136-1005 - Phone
- (305) 243-5600
- Fax
- (305) 243-4595
- NPI assigned
- Feb 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 753154100 | FL | Primary |
| Developmental Therapist | 222Q00000X | FL |
Addresses
Primary practice location
1601 NW 12TH Ave
Miami, FL 33136-1005
Mailing address
1601 NW 12TH Ave
Miami, FL 33136-1005
Phone (305) 243-5600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 753154100 | Medicaid | FL |
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 |
|---|---|---|---|
| 753154100 | FL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473984000000",
"number": "1881735355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 NW 12TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331361005",
"telephone_number": "305-243-5600",
"fax_number": "305-243-4595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 NW 12TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331361005",
"telephone_number": "305-243-5600",
"fax_number": "305-243-4595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS-SAMUELS",
"first_name": "GWENDOLYN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-09",
"last_updated": "2016-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "FL",
"license": "753154100",
"primary": true
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "FL",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "753154100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.