Provider Demographics
NPI:1841517919
Name:DEERROSE, BRIES ERIK (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRIES
Middle Name:ERIK
Last Name:DEERROSE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 NORTHLAKE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1650
Mailing Address - Country:US
Mailing Address - Phone:513-247-2814
Mailing Address - Fax:
Practice Address - Street 1:11500 NORTHLAKE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1650
Practice Address - Country:US
Practice Address - Phone:513-247-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004248103T00000X, 101Y00000X
101YM0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program