BREA O SAMUEL CLARKE, LMSW — NPI 1760342950 (Licensed & Credentialed Social Worker in NORTH CREEK, NY)

CMS-1500 Box 24J / 33a • NPI

1760342950

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

104100000X

Licensed & Credentialed Social Worker

Box 32 Service Location & ZIP+4

326 STATE ROUTE 28N, NORTH CREEK, NY, 12853-3903

✓ 9-Digit EDI 837 ZIP+4 (12853-3903)

Practice Phone & Referral Fax

(518) 791-2966

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1760342950 (BREA O SAMUEL CLARKE, LMSW) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1760342950` (NPI-1 Individual Practitioner)
Provider / Legal Name	BREA O SAMUEL CLARKE, LMSW
Plain-English Specialty	Licensed & Credentialed Social Worker NUCC Code: `104100000X` (Social Worker)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	326 STATE ROUTE 28N, NORTH CREEK, NY, 12853-3903
Practice Telephone / Fax	Tel: (518) 791-2966
Administrative Mailing Address	42 HUNTER BROOK LN # E, QUEENSBURY, NY, 12804-5858
Enumeration & Last Sync	Enumerated: 2025-11-12 \| CMS Record Updated: 2025-11-12

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

326 STATE ROUTE 28N, NORTH CREEK, NY, 12853-3903

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Plain-English Taxonomy & CMS Crosswalk (104100000X)

What Does Taxonomy Code 104100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 104100000X translates to:
"Licensed & Credentialed Social Worker"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BREA O SAMUEL CLARKE, LMSW)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`104100000X` — Social Worker Plain English: Licensed & Credentialed Social Worker	State: NY \| License: `129463` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BREA O SAMUEL CLARKE, LMSW (NPI #1760342950)