Carol A Derucki, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39002267A Issued in IN

Practice address

330 Lakeview Dr
Goshen, IN 46528-7000

Phone

(574) 537-2652

Fax

(574) 537-2652

NPI assigned

Feb 4, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Oaklawn Psychiatric Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Elkhart, IN
  • NPI 1598847212
  Medicare reassignment

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

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1831421668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 LAKEVIEW DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465287000",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 LAKEVIEW DR",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465287000",
            "telephone_number": "574-537-2652",
            "fax_number": "574-537-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUCKI",
        "first_name": "CAROL",
        "middle_name": "A",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-04",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39002267A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter M Delneky, MD
• Michael Glen Delucenay
• Dental Center of Goshen PLLC
• Michael S. Deranek, MSW, LSW, CSAYP
• Susan Kay Derrickson, NP-BC
• Sarah Detro
• Aaron Blaine Detwiler, MSW, LCSW
• Jamie Marie Detwiler, FNP-BC
• John Hanlan Deuschle, D.D.S.
• Nathaniel T Dew, MD

• Mental Health Counselor in Goshen, IN
• Providers in Goshen, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.