Healthcare Provider Details

I. General information

NPI: 1992314694
Provider Name (Legal Business Name): RYAN DERICO LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 BISCAYNE BLVD APT 103
NORTH MIAMI BEACH FL
33181-1551
US

IV. Provider business mailing address

14040 BISCAYNE BLVD APT 103
NORTH MIAMI BEACH FL
33181-1551
US

V. Phone/Fax

Practice location:
  • Phone: 786-309-3442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005418A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: