Provider Demographics
NPI:1740672625
Name:HOPPERTON, DERRICK (MSW, LISW-S)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:HOPPERTON
Suffix:
Gender:M
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23289 SWITZER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-1064
Mailing Address - Country:US
Mailing Address - Phone:440-665-0437
Mailing Address - Fax:
Practice Address - Street 1:23289 SWITZER RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-1064
Practice Address - Country:US
Practice Address - Phone:440-665-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1201376-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical