Provider Demographics
NPI:1992942361
Name:CAVE DERSHAM, D CHARMAINE (MSED CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:D CHARMAINE
Middle Name:
Last Name:CAVE DERSHAM
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WASHINGTON AVE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-456-3268
Mailing Address - Fax:518-464-1469
Practice Address - Street 1:127 BLOOMINGROVE DRIVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-283-4921
Practice Address - Fax:518-687-0375
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN.Y.007361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist