Provider Demographics
NPI:1073173043
Name:DERRY, DANYELLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DANYELLE
Middle Name:
Last Name:DERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:DANYELLE
Other - Middle Name:
Other - Last Name:DERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DANYELLE DERRY, LMSW
Mailing Address - Street 1:2532 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4040
Mailing Address - Country:US
Mailing Address - Phone:410-361-0280
Mailing Address - Fax:
Practice Address - Street 1:6999 REISTERSTOWN RD STE 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1492
Practice Address - Country:US
Practice Address - Phone:410-361-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19634101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health