NPIMap

Individual provider Active NPI

M Annette Samulowitz, LCSW

  • Clinical Social Worker
  • Southbury, CT
National Provider Identifier
1891775888
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
004439 Issued in CT
Practice address
22 Old Waterbury Road
Suite 105
Southbury, CT 06488
Phone
(203) 214-8665
NPI assigned
Jan 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 004439 CT Primary

Addresses

Primary practice location

22 Old Waterbury Road
Suite 105
Southbury, CT 06488

Mailing address

1073 Whitney Avenue
Hamden, CT 06517
Phone (203) 214-8665

Other identifiers 8

IdentifierTypeStateIssuer
158189OtherVALUE OPTIONS
237349OtherHEALTHNET
87726OtherUNITED BEHAVIORAL
140004439CT07OtherANTHEM SOUTHBURY
237349OtherMENTAL HEALTH NETWORK
87726OtherUNITED HEALTHCARE
140004439CT05OtherANTHEM HAMDEN
24553OtherCIGNA

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
004439CTMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bristol Hospital Multi-Specialty Group, Inc. Clinical Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891775888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1073 WHITNEY AVENUE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "06517",
            "telephone_number": "203-214-8665",
            "fax_number": "203-773-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 OLD WATERBURY ROAD",
            "address_2": "SUITE 105",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "06488",
            "telephone_number": "203-214-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMULOWITZ",
        "first_name": "M",
        "middle_name": "ANNETTE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "004439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "158189",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "237349",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL",
            "identifier": "87726",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM SOUTHBURY",
            "identifier": "140004439CT07",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH NETWORK",
            "identifier": "237349",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "87726",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM HAMDEN",
            "identifier": "140004439CT05",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "24553",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.