Provider Demographics
NPI:1659993236
Name:YAGER-ELORRIAGA, DERIK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DERIK
Middle Name:
Last Name:YAGER-ELORRIAGA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4008
Mailing Address - Country:US
Mailing Address - Phone:717-321-4668
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST STE 710
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4006
Practice Address - Country:US
Practice Address - Phone:267-428-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018715103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling