Provider Demographics
NPI:1912312810
Name:CIARUFFOLI, DEREK (LPC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:CIARUFFOLI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SNOWDEN ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5009
Mailing Address - Country:US
Mailing Address - Phone:570-406-9350
Mailing Address - Fax:
Practice Address - Street 1:675 WYOMING AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3831
Practice Address - Country:US
Practice Address - Phone:570-406-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC008743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)