Samuel Fuller

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12920621-3501 Issued in UT

Practice address

3440 S 500 E Apt 88
Salt Lake City, UT 84106-1280

Phone

(801) 773-7060

NPI assigned

Jul 25, 2016

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 30, 2025.

{
    "created_epoch": "1469404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753833600000",
    "number": "1982157194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 S 500 E APT 88",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841061280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 S 500 E APT 88",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841061280",
            "telephone_number": "801-773-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-25",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "12920621-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Fuller, MD
• Matthew Fuller
• Matthew Joseph Fuller, M.D.
• Polly Fuller, RN
• Ryan Tueller Fuller, DPT
• Timothy Fuller
• Trenton C. Fuller, MD
• Chase Brandon Fullerton, PA
• Tamra Fullerton, LCSW
• Burton Fullmer, LPC

• All providers in Salt Lake City, UT
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.