Provider Demographics
NPI:1679919633
Name:PARKER, DEREK J (MA, MS, PHD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:J
Last Name:PARKER
Suffix:
Gender:M
Credentials:MA, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1403
Mailing Address - Country:US
Mailing Address - Phone:814-221-5744
Mailing Address - Fax:
Practice Address - Street 1:56 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1403
Practice Address - Country:US
Practice Address - Phone:814-221-5744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health