Healthcare Provider Details

I. General information

NPI: 1124941265
Provider Name (Legal Business Name): DERICK FIEDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 WASHINGTON BLVD
EASTON PA
18042-4623
US

IV. Provider business mailing address

635 5TH AVE
BETHLEHEM PA
18018-5234
US

V. Phone/Fax

Practice location:
  • Phone: 610-440-4023
  • Fax:
Mailing address:
  • Phone: 814-440-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: