Healthcare Provider Details

I. General information

NPI: 1134519234
Provider Name (Legal Business Name): DAMARIS SARAHY MOSHARAF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAMARIS SARAY LOPEZ-MOSHARAF LCSW

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 N MAIN ST
FORT WORTH TX
76164-8511
US

IV. Provider business mailing address

2106 N MAIN ST
FORT WORTH TX
76164-8511
US

V. Phone/Fax

Practice location:
  • Phone: 817-625-4254
  • Fax: 512-291-5657
Mailing address:
  • Phone: 817-625-4254
  • Fax: 512-291-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number56168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: