Provider Demographics
NPI:1073695540
Name:HAWKINS, DEREK (LCSW)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FARBER DRIVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713
Mailing Address - Country:US
Mailing Address - Phone:631-286-0700
Mailing Address - Fax:631-286-0688
Practice Address - Street 1:11 FARBER DRIVE
Practice Address - Street 2:UNIT D
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713
Practice Address - Country:US
Practice Address - Phone:631-286-0700
Practice Address - Fax:631-286-0688
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical