Provider Demographics
NPI:1649825761
Name:CARVALHO, DEREK ANTHONY
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ANTHONY
Last Name:CARVALHO
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 1:400 WASHINGTON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:178 WINTER ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-3326
Practice Address - Country:US
Practice Address - Phone:781-331-0690
Practice Address - Fax:781-331-0685
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health