Latisha Marie Derys, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW18118 Issued in FL

Practice address

7481 W Oakland Park Blvd Ste 100
Tamarac, FL 33319-4985

Phone

(954) 771-7743

Fax

(954) 771-7748

NPI assigned

Jun 2, 2021

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

Other names 1

• Mrs. Latisha Marie Derys Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1841866548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 NE 125TH ST STE 300",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331615833",
            "telephone_number": "888-852-6672",
            "fax_number": "305-891-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7481 W OAKLAND PARK BLVD STE 100",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333194985",
            "telephone_number": "954-771-7743",
            "fax_number": "954-771-7748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERYS",
        "first_name": "LATISHA",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW18118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LATISHA",
            "last_name": "DERYS",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Social Worker in Tamarac, FL
• Providers in Tamarac, 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 Apr 20, 2022; 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.