AMANDA RUTH DERBY
NPI 1912402157
Psychologist - Clinical Child & Adolescent in Brighton, MA

Q: What is Amanda Derby's NPI number?

The NPI number for Amanda Derby is 1912402157. It was assigned to this individual provider in the NPPES registry on March 29, 2018.

Q: What is Amanda Derby's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Derby was last updated on July 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 29, 2018PECOS Enrolled

30 WARREN ST, BRIGHTON, MA 02135(617) 254-3800 Get Directions Write a Review

NPPES record last updated: July 28, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 28, 2022, Mar 29, 2018 (2 updates tracked since 2018).

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About Amanda Ruth Derby NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMANDA RUTH DERBY (NPI 1912402157) is an individual clinical child & adolescent provider in Brighton, Massachusetts and active in the NPI registry since March 2018. She is enrolled in Medicare PECOS, maintains a secondary practice location in Natick, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1912402157

Entity TypeIndividualFemale

Primary Taxonomy103TC2200X

Provider Legal NameAMANDA RUTH DERBY

Location Address30 WARREN STBrighton, MA 02135-3602

Mailing Address30 Warren StBrighton, MA 02135-3602 · (617) 254-3800

Phone(617) 254-3800

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateMarch 29, 2018

Last NPPES UpdateJuly 28, 20222 updates tracked since enumeration

NPPES CertifiedJuly 28, 2022

✔ NPI 1912402157 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · Clinical Child & AdolescentBehavioral Health & Social Service Providers

Taxonomy Code103TC2200X

Definition

A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology is an understanding of the basic psychological needs of children and adolescents, and how the family and other social contexts influence the socio-emotional adjustment, cognitive development, behavioral adaptation and health status of children and adolescents.

Also ListedBehavior AnalystTaxonomy 103K00000X

30 WARREN ST, Brighton, MA 02135

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Secondary Practice Location 1

Location 149 Eliot StNatick, MA 01760-5574 · Phone (508) 359-6582

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amanda Ruth Derby is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID345739561

PECOS Enrollment IDI20251029000209

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Amanda Derby reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

North Shore Medical Center, Inc.

16 mi

General Acute Care Hospital

81 HIGHLAND AVE
Salem, MA 01970

Reassigned Medicare billing, Massachusetts enrollment
94 clinicians in this Medicare group

NPI 1730121633 (978) 354-2065

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHERINE NILDA VISCARRA RN

Registered Nurse

30 WARREN ST
BRIGHTON, MA 02135

Suffolk County (617) 254-3800

DR. ALISON MCVEY PT, DPT

Physical Therapist

30 WARREN ST
BRIGHTON, MA 02135

Suffolk County (617) 254-3800

ALEX EDUARDO SANTOS LCSW

Social Worker (Clinical)

30 WARREN ST
BRIGHTON, MA 02135

Suffolk County (617) 955-1564

ROSE MINICHIELLO

Music Therapist

30 WARREN ST
BRIGHTON, MA 02135

Suffolk County (617) 254-3800

ABIGAIL LOUISE COOK FNP-C

Nurse Practitioner (Pediatrics)

30 WARREN ST
BOSTON, MA 02135

Suffolk County (617) 254-3800

ALICE FREEMAN GOODRICH LICSW

Social Worker (Clinical)

30 WARREN ST
BRIGHTON, MA 02135

Suffolk County (617) 779-1685

ASIYA BAKSH MS

Occupational Therapist

30 WARREN ST
BOSTON, MA 02135

Suffolk County (617) 254-3800

SHANNON BYRNE PT, DPT

Physical Therapist

30 WARREN ST
BRIGHTON, MA 02135

Suffolk County (617) 254-3800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Amanda Derby's NPI number?

The NPI number for Amanda Derby is 1912402157. It was assigned to this individual provider in the NPPES registry on March 29, 2018.

Where is Amanda Derby located?

Amanda Derby practices at 30 Warren St, Brighton, MA 02135. The listed phone number is (617) 254-3800.

What is Amanda Derby's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical Child & Adolescent, with taxonomy code 103TC2200X.

Is Amanda Derby enrolled in Medicare?

Yes. Amanda Derby is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Amanda Derby's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Amanda Derby reassigns Medicare benefits to North Shore Medical Center, Inc. (Salem, MA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Amanda Derby's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Amanda Derby was last updated on July 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.