MEDICARE: SAMUEL ROBERT MYRICK LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW17232	FL
2	104100000X	Social Worker	MSW007015	GA

General Provider Information

NPI Number	:	1316496045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL ROBERT MYRICK LSW

Provider Business Mailing Address
First Line	:	123 W HOLLYWOOD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-4041
Country	:	US
Telephone Number	:	850-363-7161
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W HOLLYWOOD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-4041
Country	:	US
Telephone Number	:	850-363-7161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	04/17/2026

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Directions to “ SAMUEL ROBERT MYRICK LSW” Practice Location

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