Provider Demographics
NPI:1912449307
Name:SAUNDERS, DEREK (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3419
Mailing Address - Country:US
Mailing Address - Phone:646-621-6983
Mailing Address - Fax:718-795-1653
Practice Address - Street 1:578 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3419
Practice Address - Country:US
Practice Address - Phone:646-621-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055275-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical