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General NPI Number Information
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NPI Number | 1558214205
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Entity Type | Individual
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Provider Name | DEREK ANDRUCKO
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Gender | Male
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 1470 MARIA LN STE 240
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5399
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Country | US
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Telephone | 510-694-4359
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Fax |
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Provider Business Mailing Address
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Address Line | 507 CAULFIELD CT
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City | CLAYTON
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State | CA
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Zip | 94517-1006
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Country | US
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Telephone | 925-222-0628
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 145358
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License Number State | CA
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