Provider Demographics
NPI:1447583687
Name:FANT, DANIELA MARTA (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:MARTA
Last Name:FANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-2069
Mailing Address - Country:US
Mailing Address - Phone:281-837-0212
Mailing Address - Fax:281-837-0670
Practice Address - Street 1:2307 N ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520
Practice Address - Country:US
Practice Address - Phone:281-837-0212
Practice Address - Fax:281-837-0670
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical