Provider Demographics
NPI:1740414812
Name:ALLEN, DERRICK (MS)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:DERRICK
Other - Middle Name:W
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:2019 BELMAR ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-7103
Mailing Address - Country:US
Mailing Address - Phone:901-644-9704
Mailing Address - Fax:
Practice Address - Street 1:2019 BELMAR ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-7103
Practice Address - Country:US
Practice Address - Phone:901-644-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker