Provider Demographics
NPI:1033779392
Name:DERR, GENEVIEVE (LMHC)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:DERR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:185 DEVONSHIRE ST STE 503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 DEVONSHIRE ST STE 503
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1415
Practice Address - Country:US
Practice Address - Phone:617-906-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC12513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health