Provider Demographics
NPI:1609232735
Name:COMPERATORE, DERIK M (LSW)
Entity type:Individual
Prefix:MR
First Name:DERIK
Middle Name:M
Last Name:COMPERATORE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 CONEMAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-1728
Mailing Address - Country:US
Mailing Address - Phone:814-515-4766
Mailing Address - Fax:
Practice Address - Street 1:767 SCOTCH VALLEY RD STE 3A
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-6601
Practice Address - Country:US
Practice Address - Phone:814-934-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
PASW133095104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker