Provider Demographics
NPI:1538200399
Name:DERBY, JOYCE FIVEHOUSE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:FIVEHOUSE
Last Name:DERBY
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 1:4900 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2972
Mailing Address - Country:US
Mailing Address - Phone:301-570-1513
Mailing Address - Fax:310-260-8218
Practice Address - Street 1:2915 OLNEY SANDY SPRING RD STE B
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-3502
Practice Address - Country:US
Practice Address - Phone:301-570-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03079103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD124466OtherAPS
MH3838 0001OtherBLUE CROSS BLUE SHIELD
MD556DMedicare ID - Type Unspecified