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General NPI Number Information
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NPI Number | 1518331305
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Entity Type | Individual
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Provider Name | COURTNEY DERICO PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 8704 S SEPULVEDA BLVD # 1076
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City | WESTCHESTER
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State | CA
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Zip | 90045-4004
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Country | US
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Telephone | 334-220-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 8704 S SEPULVEDA BLVD # 1076
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City | WESTCHESTER
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State | CA
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Zip | 90045-4004
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Country | US
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Telephone | 334-220-0200
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35601
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35601
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License Number State | CA
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