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General NPI Number Information
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NPI Number | 1023423381
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Entity Type | Individual
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Provider Name | CHRISTINA MARIE DERBIDGE PHD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 30 N 1900 E ROOM SOM 1-B620
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0002
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Country | US
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Telephone | 801-581-6228
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N 1900 E ROOM SOM 1-B620
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0002
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Country | US
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Telephone | 801-581-6228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8927950-2501
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License Number State | UT
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