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NPI Code Detail

MEDICARE: MRS. DONITA TSU MATCOVSCHI LMSW

MEDICARE: MRS. DONITA TSU MATCOVSCHI LMSW
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
1104100000XSocial Worker33316TX

General Provider Information

NPI Number : 1164541694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONITA TSU MATCOVSCHI LMSW
Provider Business Mailing Address
First Line : 305 SPANISH OAK DR
Second Line :
City : LAKE DALLAS
State : TX
Zip : 75065-2293
Country : US
Telephone Number : 214-995-4070
Fax Number : 940-497-0152
Provider Business Practice Location Address
First Line : 2535 LONE STAR DR
Second Line :
City : DALLAS
State : TX
Zip : 75212-6313
Country : US
Telephone Number : 469-533-2896
Fax Number : 214-741-3655
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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