| Doctor Name: | MR. ELOYD DERICO |
| NPI Number: | 1063734119 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LGSW |
| License Number: | 2518G |
| Business Practice Address: | 2400 Hospital Rd Tuskegee, AL - 360835001 |
| Business Phone Number: | 3347270550 |
| Business Fax Number: | |
| Mailing Address: | 2400 Hospital Rd, TUSKEGEE |
| State: | AL |
| Postal Code: | 360835001 |
| Phone Number: | 3347270550 |
| Fax Number: | |
| NPI Enumeration Date: | 02/17/2010 |
| NPI Last Update Date: | 02/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2518G |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |