Provider Demographics
NPI:1508081555
Name:DERBY, PAMELA FAYE (MS)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:FAYE
Last Name:DERBY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:FAYE
Other - Last Name:DERBY STEINWEG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2727 N GRANDVIEW BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1671
Mailing Address - Country:US
Mailing Address - Phone:262-547-5567
Mailing Address - Fax:262-421-5477
Practice Address - Street 1:2727 N GRANDVIEW BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1671
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:262-421-5477
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3576-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical