Healthcare Provider Details

I. General information

NPI: 1801944186
Provider Name (Legal Business Name): SIDNEY D PICK LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S CALIFORNIA AVE
CHICAGO IL
60608-1858
US

IV. Provider business mailing address

PO BOX 7227
WESTCHESTER IL
60154-7227
US

V. Phone/Fax

Practice location:
  • Phone: 773-522-2010
  • Fax:
Mailing address:
  • Phone: 708-786-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: