Active NPI
Juerita White
- Clinical Social Worker
- Chicago, IL
National Provider Identifier
1679247936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 150008656
- Practice address
- 1715 E 95TH St
Chicago, IL 60617-4708 - Phone
- (773) 684-4437
- Fax
- (773) 564-3515
- NPI assigned
- Aug 2, 2021
- Last updated
- Aug 2, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 150008656 | IL | Primary |
Addresses
Primary practice location
1715 E 95TH St
Chicago, IL 60617-4708
Mailing address
PO Box 746721
Atlanta, GA 30374-6721
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 |
|---|---|---|---|
| 150008656 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627862400000",
"number": "1679247936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 746721",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303746721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1715 E 95TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606174708",
"telephone_number": "773-684-4437",
"fax_number": "773-564-3515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "JUERITA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-02",
"last_updated": "2021-08-02",
"certification_date": "2021-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "150008656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.