MS. SAMANTHA CLARK LICSW
NPI 1477214898
Social Worker in Bridgeport, WV

Q: What is Samantha Clark's NPI number?

The NPI number for Samantha Clark is 1477214898. It was assigned to this individual provider in the NPPES registry on January 7, 2022.

Q: What is Samantha Clark's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Q: When was this NPI record last updated?

The NPPES record for Samantha Clark was last updated on April 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 07, 2022PECOS EnrolledAccepts Medicare Assignment

120 PROFESSIONAL PL STE 101, BRIDGEPORT, WV 26330(304) 513-3495(800) 734-8498 Get Directions Write a Review

NPPES record last updated: April 9, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 9, 2026, Jul 17, 2023, Jan 7, 2022 (3 updates tracked since 2022).

On this page

About Ms. Samantha Clark Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. SAMANTHA CLARK LICSW (NPI 1477214898) is an individual social worker in Bridgeport, West Virginia, licensed in West Virginia (DP00946604) and active in the NPI registry since January 2022. She is enrolled in Medicare PECOS, maintains a secondary practice location in Fairmont, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1477214898

Entity TypeIndividualFemale

Primary Taxonomy104100000X

Provider Legal NameMS. SAMANTHA CLARKCredential: LICSW

Location Address120 PROFESSIONAL PL STE 101Bridgeport, WV 26330-4599

Mailing Address1005 White Willow WayMorgantown, WV 26505-6119 · (304) 513-3495 · Fax (800) 734-8498

Phone(304) 513-3495

Fax(800) 734-8498

Sole ProprietorYes

Medical School CMSOtherGraduated 2020

Enumeration DateJanuary 7, 2022

Last NPPES UpdateApril 9, 20263 updates tracked since enumeration

NPPES CertifiedApril 9, 2026

✔ NPI 1477214898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers

Taxonomy Code104100000X

Licenses✔ Licensed in WV · DP00946604✔ Licensed in PA · 138525

Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

120 PROFESSIONAL PL STE 101, Bridgeport, WV 26330

Open in Google Maps ↗

Secondary Practice Location 1

Location 114 E Grafton Rd Ste CFairmont, WV 26554-4465 · Phone (304) 366-5832

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Samantha Clark Licsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1052895810

PECOS Enrollment IDI20260319001128

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASHLEY ERIN FIZER MSW, LGSW

Social Worker (Clinical)