Provider Demographics
NPI:1396569018
Name:DERR, PATRICIA C (MED)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:DERR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 EASTON RD STE B1
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2536
Mailing Address - Country:US
Mailing Address - Phone:267-354-0691
Mailing Address - Fax:
Practice Address - Street 1:607 EASTON RD STE B1
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2536
Practice Address - Country:US
Practice Address - Phone:267-354-0691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor