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NPI Code Detail

MEDICARE: AIMEE MICHELLE DERRICO

MEDICARE: AIMEE MICHELLE DERRICO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPT044NV
2106H00000XMarriage & Family TherapistMI1172NV
3225400000XRehabilitation Practitioner
4106H00000XMarriage & Family Therapist4094NV

General Provider Information

NPI Number : 1811343098
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIMEE MICHELLE DERRICO
Provider Business Mailing Address
First Line : 6417 EAGLE POINT RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-5347
Country : US
Telephone Number : 725-333-4566
Fax Number :
Provider Business Practice Location Address
First Line : 5803 W CRAIG RD STE 105
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-2537
Country : US
Telephone Number : 702-901-5200
Fax Number : 702-901-5201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2016
Last Update Date : 03/10/2023

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Directions to “ AIMEE MICHELLE DERRICO ” Practice Location

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