Provider Demographics
NPI:1215446570
Name:DERBY, WILLIAM (BA, MPS, CAP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DERBY
Suffix:
Gender:M
Credentials:BA, MPS, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6653
Mailing Address - Country:US
Mailing Address - Phone:954-357-4821
Mailing Address - Fax:
Practice Address - Street 1:900 NW 31ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6653
Practice Address - Country:US
Practice Address - Phone:954-357-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)