Provider Demographics
NPI:1811178932
Name:ROEMER, DEREK VON SR (PHD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:VON
Last Name:ROEMER
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-5183
Mailing Address - Country:US
Mailing Address - Phone:814-432-4355
Mailing Address - Fax:814-432-9128
Practice Address - Street 1:1 DALE DRIVE
Practice Address - Street 2:MH/MR BASE SERVICE UNIT
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323
Practice Address - Country:US
Practice Address - Phone:814-671-8888
Practice Address - Fax:814-432-9128
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005187L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01535160Medicaid