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NPI Code Detail

MEDICARE: DAMARIS SARAHY MOSHARAF LCSW

MEDICARE: DAMARIS SARAHY MOSHARAF LCSW
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
11041C0700XClinical Social Worker56168TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
156168OTHERTXLICENSE

General Provider Information

NPI Number : 1134519234
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMARIS SARAHY MOSHARAF LCSW
Provider Business Mailing Address
First Line : 2106 N MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-8511
Country : US
Telephone Number : 817-625-4254
Fax Number : 512-291-5657
Provider Business Practice Location Address
First Line : 2106 N MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-8511
Country : US
Telephone Number : 817-625-4254
Fax Number : 512-291-5657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2015
Last Update Date : 01/27/2015

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