Provider Demographics
NPI:1033374947
Name:DERBYSHIRE, TODD STUART (BA)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:STUART
Last Name:DERBYSHIRE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E GROVE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2737
Mailing Address - Country:US
Mailing Address - Phone:800-273-6277
Mailing Address - Fax:
Practice Address - Street 1:165 E GROVE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2737
Practice Address - Country:US
Practice Address - Phone:800-273-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA8644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical