MEDICARE: MS. STEPHANIE DARSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	23402	TX

General Provider Information

NPI Number	:	1013015833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE DARSA

Provider Business Mailing Address
First Line	:	902 W MITCHELL ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2537
Country	:	US
Telephone Number	:	817-461-6183
Fax Number	:	817-265-7433

Provider Business Practice Location Address
First Line	:	902 W MITCHELL ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2537
Country	:	US
Telephone Number	:	817-461-6183
Fax Number	:	817-265-7433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/05/2012

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