Provider Demographics
NPI:1578193686
Name:MCCLUSKEY, DERRICK STANLEY
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:STANLEY
Last Name:MCCLUSKEY
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 1:1 ARCH PL STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2457
Mailing Address - Country:US
Mailing Address - Phone:413-774-1000
Mailing Address - Fax:
Practice Address - Street 1:1 ARCH PL STE 1
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2457
Practice Address - Country:US
Practice Address - Phone:413-774-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor