Provider Demographics
NPI:1871382341
Name:BROWN, DERICK PATRICK
Entity type:Individual
Prefix:
First Name:DERICK
Middle Name:PATRICK
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DERICK
Other - Middle Name:PATRICK
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 WING FOOT CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1147
Mailing Address - Country:US
Mailing Address - Phone:386-898-8286
Mailing Address - Fax:
Practice Address - Street 1:100 WING FOOT CIR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1147
Practice Address - Country:US
Practice Address - Phone:386-898-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW243891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical