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NPI Code Detail

MEDICARE: SHANNON LEE DERBY LMHC, CAC

MEDICARE: SHANNON LEE DERBY LMHC, CAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCAC.100099FL
2101YM0800XMental Health CounselorMH17175FL

General Provider Information

NPI Number : 1962365940
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON LEE DERBY LMHC, CAC
Provider Business Mailing Address
First Line : 28 LORD RD STE 215
Second Line :
City : MARLBOROUGH
State : MA
Zip : 01752-4549
Country : US
Telephone Number : 781-666-2711
Fax Number :
Provider Business Practice Location Address
First Line : 28 LORD RD STE 215
Second Line :
City : MARLBOROUGH
State : MA
Zip : 01752-4549
Country : US
Telephone Number : 781-666-2711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2025
Last Update Date : 07/01/2026

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