Provider Demographics
NPI:1902147333
Name:DERBYSHIRE, DEBRA L (PHD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:DERBYSHIRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3872 E HARBOR LIGHT LANDING DR
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3877
Mailing Address - Country:US
Mailing Address - Phone:877-734-2031
Mailing Address - Fax:877-734-2030
Practice Address - Street 1:205 SE CATAWBA RD
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2666
Practice Address - Country:US
Practice Address - Phone:419-734-3333
Practice Address - Fax:419-734-3335
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical