Provider Demographics
NPI:1841522398
Name:TERRELL, DEREK T (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:T
Last Name:TERRELL
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MAIN STREET EXT UNIT 3560
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02361-7028
Mailing Address - Country:US
Mailing Address - Phone:617-792-6144
Mailing Address - Fax:
Practice Address - Street 1:44 FREEMAN DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-6887
Practice Address - Country:US
Practice Address - Phone:617-792-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405612363LP0808X
NJ26NJ14940700363LP0808X
MARN2326087363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health