Provider Demographics
NPI:1366993933
Name:NEAZ-NIBUR, DEREK JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JOSEPH
Last Name:NEAZ-NIBUR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DEPOT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5130
Mailing Address - Country:US
Mailing Address - Phone:413-499-4090
Mailing Address - Fax:
Practice Address - Street 1:34 DEPOT ST STE 201
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5130
Practice Address - Country:US
Practice Address - Phone:413-499-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist