Active NPI
Jeanne V Crockett, L.C.S.W.
- Clinical Social Worker
- Fort Worth, TX
National Provider Identifier
1306909890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- S27688
- Practice address
- 3840 Hulen St
HTN, Client Accounting
Fort Worth, TX 76107-7277 - Phone
- (817) 569-4395
- Fax
- (817) 569-4517
- NPI assigned
- Dec 18, 2006
- Last updated
- Jan 19, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S27688 | TX | |
| Clinical Social Worker | 1041C0700X | S27688 | TX | Primary |
Addresses
Primary practice location
3840 Hulen St
HTN, Client Accounting
Fort Worth, TX 76107-7277
Mailing address
3840 Hulen St
HTN, Client Accounting
Fort Worth, TX 76107-7277
Phone (817) 569-4395
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071171502 | Medicaid | TX | |
| 87607Q | Other | TX | BCBS TX PROVIDER# |
| 071171503 | Medicaid | TX | |
| 071171504 | Medicaid | TX |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S27688 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295395200000",
"number": "1306909890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3840 HULEN ST",
"address_2": "HTN, CLIENT ACCOUNTING",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761077277",
"telephone_number": "817-569-4395",
"fax_number": "817-569-4517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3840 HULEN ST",
"address_2": "HTN, CLIENT ACCOUNTING",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761077277",
"telephone_number": "817-569-4395",
"fax_number": "817-569-4517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKETT",
"first_name": "JEANNE",
"middle_name": "V",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2011-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "S27688",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "S27688",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071171502",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TX PROVIDER#",
"identifier": "87607Q",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071171503",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071171504",
"state": "TX"
}
],
"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 Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.