Healthcare Provider Details

I. General information

NPI: 1730449315
Provider Name (Legal Business Name): MICHAEL PICA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4N701 SCHOOL RD STE A
ST CHARLES IL
60175-6508
US

IV. Provider business mailing address

4N701 SCHOOL RD STE A
SAINT CHARLES IL
60175-6508
US

V. Phone/Fax

Practice location:
  • Phone: 630-549-6497
  • Fax: 630-549-0942
Mailing address:
  • Phone: 630-549-6497
  • Fax: 630-549-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL PICA
Title or Position: PRESIDENT/CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 630-373-7349