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General NPI Number Information
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NPI Number | 1356455505
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Entity Type | Individual
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Provider Name | MICHAEL PICA PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 40W222 LAFOX RD STE H1
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City | SAINT CHARLES
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State | IL
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Zip | 60175-7631
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Country | US
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Telephone | 630-549-6497
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Fax | 630-549-6497
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Provider Business Mailing Address
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Address Line | 40W222 LAFOX RD STE H1
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City | SAINT CHARLES
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State | IL
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Zip | 60175-7631
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Country | US
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Telephone | 630-549-6497
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Fax | 630-549-0942
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006217
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License Number State | IL
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