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General NPI Number Information
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NPI Number | 1659993236
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Entity Type | Individual
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Provider Name | DERIK YAGER-ELORRIAGA PHD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 1420 WALNUT ST STE 710
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4006
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Country | US
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Telephone | 267-428-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 SPRING GARDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-4008
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Country | US
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Telephone | 717-321-4668
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PS018715
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License Number State | PA
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