Provider Demographics
NPI:1194470609
Name:DERONDA, CATHRYN MARY (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:MARY
Last Name:DERONDA
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL DR FL 3
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3402
Mailing Address - Country:US
Mailing Address - Phone:304-279-2198
Mailing Address - Fax:
Practice Address - Street 1:2500 HOSPITAL DR FL 3
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3402
Practice Address - Country:US
Practice Address - Phone:304-596-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009456081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical