Individual
DERRICK LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4110 NE 122ND AVE, PORTLAND, OR 97230-1300
(971) 227-3553
Mailing address
20679 SW EDGEMONT ST, BEAVERTON, OR 97003-6048
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
OR
Other
Enumeration date
07/30/2026
Last updated
07/30/2026
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