Provider Demographics
NPI:1689884546
Name:DEREKSEN, NANCY
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:DEREKSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:JANE
Other - Last Name:OLSGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:111 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1419
Mailing Address - Country:US
Mailing Address - Phone:014-738-4226
Mailing Address - Fax:
Practice Address - Street 1:111 SECOND AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1419
Practice Address - Country:US
Practice Address - Phone:914-738-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025105-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical