Individual
DEREK ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 MAPLE ST, LYNN, MA 01904-2710
(781) 913-5044
Mailing address
210 MAPLE ST, LYNN, MA 01904-2710
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/07/2019
Last updated
10/07/2019
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