Active NPI
Samantha D Clark, LMSW
- Social Worker
- Johnson City, TN
National Provider Identifier
1982176483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSW0000010976
- Practice address
- 809 Lamont St
Johnson City, TN 37604-5453 - Phone
- (423) 335-0863
- NPI assigned
- Dec 20, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LSW0000010976 | TN | Primary |
Addresses
Primary practice location
809 Lamont St
Johnson City, TN 37604-5453
Mailing address
809 Lamont St
Johnson City, TN 37604-5453
Phone (423) 926-1171
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 |
|---|---|---|---|
| LSW0000010976 | TN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552867200000",
"number": "1982176483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "809 LAMONT ST",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376045453",
"telephone_number": "423-926-1171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "809 LAMONT ST",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376045453",
"telephone_number": "423-335-0863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SAMANTHA",
"middle_name": "D",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-20",
"last_updated": "2019-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TN",
"license": "LSW0000010976",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.