Active NPI
Bree Elizabeth Derrick, MA, CAGS, LMHC
- Mental Health Counselor
- Providence, RI
National Provider Identifier
1497028633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MCH00486
- Practice address
- 347 Broadway
Providence, RI 02909-1101 - Phone
- (401) 301-2504
- NPI assigned
- Feb 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MCH00486 | RI | Primary |
Addresses
Primary practice location
347 Broadway
Providence, RI 02909-1101
Mailing address
347 Broadway
Providence, RI 02909-1101
Phone (401) 301-2504
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MCH00486 | RI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329696000000",
"number": "1497028633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "347 BROADWAY",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029091101",
"telephone_number": "401-301-2504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "347 BROADWAY",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029091101",
"telephone_number": "401-301-2504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERRICK",
"first_name": "BREE",
"middle_name": "ELIZABETH",
"credential": "MA, CAGS, LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-20",
"last_updated": "2012-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "RI",
"license": "MCH00486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.