Provider Demographics
NPI:1801061460
Name:BURWELL, DERICK A (CRC)
Entity type:Individual
Prefix:MR
First Name:DERICK
Middle Name:A
Last Name:BURWELL
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 E 142ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1723
Mailing Address - Country:US
Mailing Address - Phone:718-993-1400
Mailing Address - Fax:718-993-0647
Practice Address - Street 1:1241 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-5336
Practice Address - Country:US
Practice Address - Phone:718-378-6500
Practice Address - Fax:718-842-3846
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY41104101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor