Active NPI
D Charmaine Cave Dersham, MS.ED. CCC-SLP
- Speech-Language Pathologist
- Troy, NY
National Provider Identifier
1992942361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- N.Y.007361
- Practice address
- 127 Bloomingrove Drive
Troy, NY 12180 - Phone
- (518) 283-4921
- Fax
- (518) 687-0375
- NPI assigned
- Jan 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | N.Y.007361 | NY | Primary |
Addresses
Primary practice location
127 Bloomingrove Drive
Troy, NY 12180
Mailing address
230 Washington Ave Ext
Albany, NY 12203
Phone (518) 456-3268
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N.Y.007361 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Early Childhood Education Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Early Intervention Provider Agency
- Albany, NY
- NPI 1861637019
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591401600000",
"number": "1992942361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 WASHINGTON AVE EXT",
"city": "ALBANY",
"state": "NY",
"postal_code": "12203",
"telephone_number": "518-456-3268",
"fax_number": "518-464-1469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 BLOOMINGROVE DRIVE",
"city": "TROY",
"state": "NY",
"postal_code": "12180",
"telephone_number": "518-283-4921",
"fax_number": "518-687-0375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVE DERSHAM",
"first_name": "D CHARMAINE",
"name_prefix": "Ms.",
"credential": "MS.ED. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-07",
"last_updated": "2020-06-06",
"certification_date": "2020-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "N.Y.007361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.