Marie Dershem, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801096208 Issued in MI

Practice address

2060 East Paris Ave SE Ste 100
Grand Rapids, MI 49546-6113

Phone

(616) 956-6100

Fax

(616) 956-6637

NPI assigned

Mar 22, 2017

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

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.

• Lora K Grabow LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1497406151
  NPD (past)

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490140800000",
    "number": "1578094553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 EAST PARIS AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466113",
            "telephone_number": "616-956-6100",
            "fax_number": "616-956-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 EAST PARIS AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466113",
            "telephone_number": "616-956-6100",
            "fax_number": "616-956-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSHEM",
        "first_name": "MARIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2017-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801096208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven T Deroos, MD
• Kathleen Anne Derosa Belmont, DC
• Elizabeth Morrow Derose, MD
• Anna Derr
• Heather A Derrick, LLBSW
• Amelia Grace Deruiter, LLMSW
• Ruth E. Deruiter, MSW,LMSW,IMH-E(III)
• John H Dery, MA, PT
• Patrick Dery, MD
• Rita M Dery, PT

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; 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.