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General NPI Number Information
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NPI Number | 1346164779
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Entity Type | Individual
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Provider Name | LAURIE EMMANUELLE DERIVOIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 1251 S SHERMAN ST # 102103
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City | RICHARDSON
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State | TX
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Zip | 75081-6514
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Country | US
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Telephone | 469-436-3290
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Fax |
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Provider Business Mailing Address
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Address Line | 5649 BOIS D ARC RD APT 2339
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City | MCKINNEY
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State | TX
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Zip | 75071-5870
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 112716
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License Number State | TX
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