Provider Demographics
NPI:1104621499
Name:SAMORA, FRANK DEREK
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:DEREK
Last Name:SAMORA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W M CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1006
Mailing Address - Country:US
Mailing Address - Phone:402-325-8555
Mailing Address - Fax:
Practice Address - Street 1:2111 W SUMNER ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1484
Practice Address - Country:US
Practice Address - Phone:402-325-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical