Provider Demographics
NPI:1770644122
Name:DERKACZ, MONICA LYNN (ACSW)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LYNN
Last Name:DERKACZ
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COHASSET RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2260
Mailing Address - Country:US
Mailing Address - Phone:530-879-3863
Mailing Address - Fax:
Practice Address - Street 1:500 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2260
Practice Address - Country:US
Practice Address - Phone:530-879-3863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA188981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical