Mary Derbish, LSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

150110706 Issued in IL

Practice address

505 W University Ave Ste 202-203
Champaign, IL 61820-3915

Phone

(224) 232-8057

NPI assigned

May 12, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Child and Family Counseling of Champaign

  • Professional Counselor
  • Champaign, IL
  • NPI 1053814848
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1003506924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W UNIVERSITY AVE STE 202-203",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203915",
            "telephone_number": "224-232-8057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W UNIVERSITY AVE STE 202-203",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203915",
            "telephone_number": "224-232-8057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERBISH",
        "first_name": "MARY",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "150110706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valarie Demuri
• Dental Professionals of Illinois, P.C. (Creative Smiles Dental Care)
• Dental Professionals of Illinois, P.C. (Hessel Park Family Dentistry)
• Dental Professionals of Illinois, P.C. (Dentistry by Design)
• Dental Professionals of Illinois, P.C. (Family Dental Care of Champaign)
• Linda A Derum, MD
• Amee Desai, DNP-FNP-BC
• Jennifer Deschler
• Desired Futures Counseling & Consulting, P.L.L.C.
• Alexis Deuel, RBT

• Clinical Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.