Shannon Lee Derby, LMHC, CAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH17175 Issued in FL

Practice address

28 Lord Rd Ste 215
Marlborough, MA 01752-4549

Phone

(781) 666-2711

NPI assigned

Dec 5, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Spectrum Neuro Behavioral Care LLC

  • Community/Behavioral Health Agency
  • North Smithfield, RI
  • NPI 1356906572

  Multi-Specialty

  NPD

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

{
    "created_epoch": "1764892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1962365940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 LORD RD STE 215",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017524549",
            "telephone_number": "781-666-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 LORD RD STE 215",
            "city": "MARLBOROUGH",
            "state": "MA",
            "postal_code": "017524549",
            "telephone_number": "781-666-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERBY",
        "first_name": "SHANNON",
        "middle_name": "LEE",
        "credential": "LMHC, CAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-12-05",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "CAC.100099",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH17175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Associates of Marlborough, Dr. Nehra LLC
• Kassandra Marie Depina
• Tameka Rashawna Deramus
• Katherine Deras
• Sallylee Derbes
• Lauren Ashley Derrick, BCBA
• Khadijah Desanges
• Elizabeth Desilets de Cardenas, LMHC
• Tiffany Noel Desimone, BT
• Ashley Marie Desko

• Mental Health Counselor in Marlborough, MA
• Providers in Marlborough, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.