Kenwyn Maeve Derby

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

2655 S Lake Erie Dr
West Valley City, UT 84120-7350

Phone

(801) 441-4900

NPI assigned

Jul 27, 2020

Sex

Female

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

Enrolled in UT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Project Connection Utah LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • West Valley City, UT
  • NPI 1366330656

  Multi-Specialty

  Medicare reassignment NPD
• Project Connection Utah

  • Mental Health Counselor
  • Salt Lake City, UT
  • NPI 1104392802

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1700495652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "882 E MILLBROOK WAY",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840102053",
            "telephone_number": "415-819-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 S LAKE ERIE DR",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841207350",
            "telephone_number": "801-441-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERBY",
        "first_name": "KENWYN",
        "middle_name": "MAEVE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Brewster Demcak, PTA
• Demille Mackay Dental
• Christopher Demille
• Jennifer J Denbleyker, MD
• Dental Associates of Utah, PC
• Payal Pritika Devi
• Devin L. Davidson, DMD PLLC
• David Frederick Diehl, PHARMD
• Dignified Love LP
• Aundrea Dilanchian

• Clinical Social Worker in West Valley City, UT
• Providers in West Valley 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 Jul 27, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.