MEDICARE: MS. ARIANA DANIELLE DETERT MSW, 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1841405768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARIANA DANIELLE DETERT MSW, LCSW

Provider Business Mailing Address
First Line	:	12345 JONES ROAD, STE. 285
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070
Country	:	US
Telephone Number	:	281-894-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	12345 JONES RD STE 285
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4958
Country	:	US
Telephone Number	:	281-894-7222
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	06/07/2011

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