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

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: July 19, 2026.

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

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
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

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.

Social Worker
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Social Worker
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Social Worker
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Counselor (Mental Health)
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Social Worker
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Social Worker (Clinical)
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Social Worker (Clinical)
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Counselor (Mental Health)
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1477214898, enumerated as an "individual" on January 07, 2022.

The provider is located at 120 PROFESSIONAL PL STE 101 BRIDGEPORT, WV 26330 and the phone number is (304) 513-3495.

Social Worker with taxonomy code 104100000X.