Provider Demographics
NPI:1134519234
Name:MOSHARAF, DAMARIS SARAHY (LCSW)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:SARAHY
Last Name:MOSHARAF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAMARIS
Other - Middle Name:SARAY
Other - Last Name:LOPEZ-MOSHARAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-8511
Mailing Address - Country:US
Mailing Address - Phone:817-625-4254
Mailing Address - Fax:512-291-5657
Practice Address - Street 1:2106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-8511
Practice Address - Country:US
Practice Address - Phone:817-625-4254
Practice Address - Fax:512-291-5657
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX561681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX56168OtherLICENSE