Anne Dyna Derival, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10027 Issued in FL

Practice address

4161 Carmichael Ave
BLDG 3300, Suite 150
Jacksonville, FL 32207-2353

Phone

(904) 396-8734

Fax

(904) 396-8759

NPI assigned

Oct 16, 2008

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1578715967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326081135",
            "telephone_number": "904-396-8734",
            "fax_number": "904-396-8759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4161 CARMICHAEL AVE",
            "address_2": "BLDG 3300, SUITE 150",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072353",
            "telephone_number": "904-396-8734",
            "fax_number": "904-396-8759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERIVAL",
        "first_name": "ANNE",
        "middle_name": "DYNA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-16",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "10027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Derderian, PHARMD
• Salem Isabella Derdock
• Anne Marie Derienzo, PT
• Victor Derienzo, PT
• James Derisse
• Michaela Annis Derival, LPN
• Jeltsje Willemien Derksen, PT
• Dermatology Group of Florida PA
• Dermatology Specialists of North Florida, P.a.
• Alexandra Derr, DO

• Clinical Social Worker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; 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.