Provider Demographics
NPI:1306209044
Name:REECE, DERICK
Entity Type:Individual
Prefix:
First Name:DERICK
Middle Name:
Last Name:REECE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PIN OAK DR
Mailing Address - Street 2:#1403
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8253
Mailing Address - Country:US
Mailing Address - Phone:207-899-9653
Mailing Address - Fax:
Practice Address - Street 1:71 US ROUTE 1
Practice Address - Street 2:SUITE H
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-774-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC158811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical