David Scott Derezotes, LCSW, PHD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1381923501 Issued in UT

Practice address

3669 Oakview Dr
Salt Lake City, UT 84124-3327

Phone

(801) 585-3546

Fax

(801) 585-3219

NPI assigned

Jun 17, 2008

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Family Counseling Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Murray, UT
  • NPI 1083704597
  NPD (past)

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213660800000",
    "number": "1487814018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3669 OAKVIEW DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243327",
            "telephone_number": "801-585-3546",
            "fax_number": "801-585-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3669 OAKVIEW DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841243327",
            "telephone_number": "801-585-3546",
            "fax_number": "801-585-3219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREZOTES",
        "first_name": "DAVID",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "LCSW, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-17",
        "last_updated": "2008-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "1381923501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Marie Derbidge, PHD
• Pauline Derbidge
• Willard Dere, M.D.
• Derek Cragun, LCSW PLLC
• Piper Lynn Dereus, RN
• Dermatology Division University of Utah Medical Center
• Kathryn Louise Derrick, RN
• Benjamin D Deru
• Tamera Lyn Derushia
• Amira Dervisevic

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.