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NPI Code Detail

MEDICARE: SAMANTHA CLARK LCSW

MEDICARE: SAMANTHA CLARK LCSW
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
11041C0700XClinical Social WorkerSW18383FL

General Provider Information

NPI Number : 1215505706
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA CLARK LCSW
Provider Business Mailing Address
First Line : 2995 DREW ST FL 2
Second Line :
City : CLEARWATER
State : FL
Zip : 33759-3012
Country : US
Telephone Number : 727-532-0002
Fax Number :
Provider Business Practice Location Address
First Line : 14527 7TH ST
Second Line :
City : DADE CITY
State : FL
Zip : 33523-3102
Country : US
Telephone Number : 727-521-1474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2021
Last Update Date : 03/05/2026

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Directions to “ SAMANTHA CLARK LCSW” Practice Location

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