Active NPI
Samanta Juric
- Clinical Social Worker
- Fort Worth, TX
National Provider Identifier
1295301547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 62106
- Practice address
- 1500 Cooper St # FL4
Fort Worth, TX 76104-2710 - Phone
- (682) 885-2500
- Fax
- (682) 885-3356
- NPI assigned
- May 27, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 62106 | TX | Primary |
Addresses
Primary practice location
1500 Cooper St # FL4
Fort Worth, TX 76104-2710
Mailing address
1500 Cooper St FL 4
Fort Worth, TX 76104-2710
Phone (682) 885-2500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62106 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622073600000",
"number": "1295301547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 COOPER ST FL 4",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761042710",
"telephone_number": "682-885-2500",
"fax_number": "682-885-3356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 COOPER ST # FL4",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761042710",
"telephone_number": "682-885-2500",
"fax_number": "682-885-3356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JURIC",
"first_name": "SAMANTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-27",
"last_updated": "2021-05-27",
"certification_date": "2021-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "62106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.