Individual
MR. JED E. DERRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW-C
Contact information
Practice address
505 E MAIN ST, Q, SALISBURY, MD 21804-5020
(410) 742-8882
Mailing address
RR 2, BOX 155A, DAGSBORO, DE 19939
(302) 539-2015
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
09463
MD
1041C0700X
Clinical Social Worker
Q10000744
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
298470900
—
MD
Enumeration date
10/04/2006
Last updated
10/18/2016
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