Provider Demographics
NPI:1700582038
Name:SABEDRA, DEREK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:SABEDRA
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:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:MD
Mailing Address - Zip Code:21869-0164
Mailing Address - Country:US
Mailing Address - Phone:410-610-4300
Mailing Address - Fax:
Practice Address - Street 1:210 RACE STREET
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:MD
Practice Address - Zip Code:21869-0164
Practice Address - Country:US
Practice Address - Phone:410-610-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional