Doctor Name: | MR. DERRICK COBB |
NPI Number: | 1205259892 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CASAC |
License Number: | 26043 |
Business Practice Address: | 7 Seafield Ln Westhampton Beach, NY - 119782714 |
Business Phone Number: | 6312058044 |
Business Fax Number: | |
Mailing Address: | Po Box 523, MASTIC |
State: | NY |
Postal Code: | 119500523 |
Phone Number: | 6312058044 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2014 |
NPI Last Update Date: | 02/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 26043 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |