Provider Demographics
NPI:1720300890
Name:DESENA, DANIEL T (LMSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:DESENA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088854104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008992490OtherBCBS PIN
MIMI6386Medicare PIN