Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Sidary Sam, MSW

Individual provider Mental Health Counselor · NPI 1962557900

Mr. Sidary Sam, MSW is a Clinical Social Worker in Long Beach, California. Qualified in 2007, 19 years ago. Practices with Community Medical Wellness Centers USA, a 30-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
19
Licensed in
CA
In the registry since
2007
Specialties on file
3
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.

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Practice location Address checks out

4510 E Pacific Coast Hwy Ste 600
Long Beach, CA 90804-6914
Phone: (562) 346-1100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW94013 (CA)
Mental Health Counselor Taxonomy 101YM0800X · Licence ASW 22278 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1962557900
Entity typeIndividual (Type 1)
GenderMale
Credentials MSW
Sole proprietorNo
NPI enumeratedJanuary 23, 2007
Last updated in NPPESMarch 8, 2021
Certification dateMarch 8, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Community Medical Wellness Centers Usa — 30 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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