Individual
MR. DEREK DYKES MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
22 MCGRATH HWY, SOMERVILLE, MA 02143-4508
(617) 623-1814
(617) 623-1817
Mailing address
10 BRIDGE ST, MARBLEHEAD, MA 01945-3711
(617) 893-2231
(617) 623-1817
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
113305
MA
Other
Enumeration date
07/28/2006
Last updated
07/08/2007
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