Individual
MR. DERRICK COBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
7 SEAFIELD LN, WESTHAMPTON BEACH, NY 11978-2714
(631) 205-8044
Mailing address
PO BOX 523, MASTIC, NY 11950-0523
(631) 205-8044
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
26043
NY
Other
Enumeration date
02/02/2014
Last updated
02/02/2014
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