Provider Demographics
NPI:1831882943
Name:DANIEL T DESENA, LMSW, PLLC
Entity type:Organization
Organization Name:DANIEL T DESENA, LMSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:TRABUE
Authorized Official - Last Name:DESENA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, PLLC
Authorized Official - Phone:734-368-7819
Mailing Address - Street 1:2002 HOGBACK RD STE 10
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9736
Mailing Address - Country:US
Mailing Address - Phone:734-368-7819
Mailing Address - Fax:
Practice Address - Street 1:2002 HOGBACK RD STE 10
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9736
Practice Address - Country:US
Practice Address - Phone:734-368-7819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)