Individual
DERRICK CASEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
484 MAIN ST, WORCESTER, MA 01608-1893
(508) 799-8010
Mailing address
442 PLANTATION ST, WORCESTER, MA 01605-2328
(774) 253-3914
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S96930234
DRIVER'S LICENSE
MA
Enumeration date
03/28/2019
Last updated
03/28/2019
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