Healthcare Provider Details

I. General information

NPI: 1568682805
Provider Name (Legal Business Name): GENETIC & DEVELOPMENTAL CENTER OF SW,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E BORDER ST L.
ARLINGTON TX
76010-7494
US

IV. Provider business mailing address

801 E BORDER ST L.
ARLINGTON TX
76010-7494
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-6400
  • Fax: 817-277-6414
Mailing address:
  • Phone: 817-277-6400
  • Fax: 817-277-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberJ2521
License Number StateTX

VIII. Authorized Official

Name: DR. MARY ESTHER CARLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 817-277-6400