Provider Demographics
NPI:1568002228
Name:PAZOLT, DEREK DANA
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:DANA
Last Name:PAZOLT
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 1:56 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2608
Mailing Address - Country:US
Mailing Address - Phone:508-580-0801
Mailing Address - Fax:
Practice Address - Street 1:56 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2608
Practice Address - Country:US
Practice Address - Phone:508-580-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker