black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

DEREK WITHAM INSURANCE AGENCY, INC.

NON-RESIDENT PRODUCER AGENCY

License Number:
AGN411426
Status:
First Licensure:
02/24/2022
Cancel Date:
None
Renewal Date:
04/01/2027

Street Location:
269 BROADWAY
MALDEN, MA 02148-4523
Mailing:
269 BROADWAY
MALDEN, MA 02148-4523
Phone:
+1 (781) 322-2886
Fax:
+1 (781) 324-0105
Email:
withaminsurance@verizon.net

History

License Type Start Date End Date
NON-RESIDENT PRODUCER AGENCY 02/24/2022 04/01/2027

Employer

Name Issue Date License Number Expiration Date Cancel Date
AMERICAN ECONOMY INSURANCE COMPANY
01/17/2023 PCF363
SAFECO NATIONAL INSURANCE COMPANY
03/03/2023 PCF248658

Affiliated Agent

Name Issue Date License Number Expiration Date Cancel Date
DEREK J. WITHAM
02/24/2022 PRN178789

Branch Office

None.

Supervised Entity

None.

Responsible Individual

Name License Number
DEREK J. WITHAM PRN178789

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
8664565

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 06/09/2025 12:03:59 PM