Most Relevant Information
Provider Data
| NPI Number: | 1003506924 |
| Provider Name: | MARY DERBISH LSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 150110706 |
Most Important Dates
| Enumeration Date: | 05/12/2023 |
| Last Updated: | 05/12/2023 |
Provider Practice Location
505 W UNIVERSITY AVE STE 202-203
CHAMPAIGN
IL
618203915
Practice Location Phone/Fax
| Phone: | 2242328057 |
| Fax: |
Provider Mailing Location
505 W UNIVERSITY AVE STE 202-203
CHAMPAIGN
IL
618203915
Provider Mailing Phone/Fax
| Phone: | 2242328057 |
| Fax: |