Derek Maurice Titus Sr.

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

30023 Issued in NY

Practice address

165 Main St Ste a
Cortland, NY 13045-3049

Phone

(607) 753-0234

Fax

(607) 753-0286

NPI assigned

Aug 30, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Glenville, NY
  • NPI 1336339969
  NPD (past)
• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Liverpool, NY
  • NPI 1366498768
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1831671460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2279 GREENWOOD RD APT 2",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130459723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 MAIN ST STE A",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130453049",
            "telephone_number": "607-753-0234",
            "fax_number": "607-753-0286"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "526 Old Liverpool Rd",
            "address_purpose": "LOCATION",
            "city": "Liverpool",
            "state": "NY",
            "postal_code": "130886238",
            "country_code": "US",
            "telephone_number": "315-453-3911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TITUS",
        "first_name": "DEREK",
        "middle_name": "MAURICE",
        "name_suffix": "Sr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-30",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "30023",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336163963",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl Anne Thurston, RN, LMSW
• Joan Tiger, LPN
• Tigress Acupuncture, PLLC
• Timeless Hearing LLC
• Judy Arlene Tinker, COTA/L
• TLC Emergency Medical Services Inc
• TLK of Cortland Inc
• Dana Todora, LCSW
• Jill Marie Toftegaard, CCC-SLP
• Jacqueline Rose Tomko, NP RNC MSN

• Addiction (Substance Use Disorder) Counselor in Cortland, NY
• Providers in Cortland, NY by specialty
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.