Provider Demographics
NPI:1356598635
Name:PAUL, DERAI ANITA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DERAI
Middle Name:ANITA
Last Name:PAUL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 N HIGHWAY 89
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2738
Mailing Address - Country:US
Mailing Address - Phone:801-451-0475
Mailing Address - Fax:801-451-8249
Practice Address - Street 1:1466 N HIGHWAY 89
Practice Address - Street 2:SUITE 220
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2738
Practice Address - Country:US
Practice Address - Phone:801-451-0475
Practice Address - Fax:801-451-8249
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6568213-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical