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General NPI Number Information
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NPI Number | 1669627444
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Entity Type | Organization
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Legal Business Name | LAURA DERR, PSYD, PC
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 1017 TURNPIKE ST SUITE 12C
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City | CANTON
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State | MA
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Zip | 02021-2853
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Country | US
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Telephone | 781-713-4707
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Fax | 781-713-4708
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Provider Business Mailing Address
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Address Line | 1017 TURNPIKE ST SUITE 12C
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City | CANTON
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State | MA
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Zip | 02021-2853
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Country | US
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Telephone | 781-713-4707
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Fax | 781-713-4708
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Authorized Official
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Title or Position | OWNER
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Name | LAURA S DERR
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Credential | PSYD
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Telephone | 781-713-4707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6680
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License Number State | MA
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