Provider Information for 1356598635
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DERAI ANITA PAUL MSW, LCSW
Sex: Female
NPI: 1356598635
Last Updated: 2008-08-19
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1356598635 | ||||||||
| Enumeration Date | 2008-08-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1466 N HIGHWAY 89 SUITE 220 FARMINGTON, UT 84025-2738 United States Phone: 801-451-0475 | Fax:801-451-8249 | ||||||||
| Primary Practice Address | 1466 N HIGHWAY 89 SUITE 220 FARMINGTON, UT 84025-2738 United States Phone: 801-451-0475 | Fax:801-451-8249 | ||||||||
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