Provider Demographics
NPI:1629785027
Name:BARROS, DEREK BARBOSA (LMHC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:BARBOSA
Last Name:BARROS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CABOT PL STE 10
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4612
Mailing Address - Country:US
Mailing Address - Phone:508-965-9403
Mailing Address - Fax:
Practice Address - Street 1:3 CABOT PL STE 10
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4612
Practice Address - Country:US
Practice Address - Phone:508-965-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13472101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor