MEDICARE: CHRISTINE' L DERICO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1063938223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE' L DERICO

Provider Business Mailing Address
First Line	:	6610 SW 18TH ST
Second Line	:
City	:	N LAUDERDALE
State	:	FL
Zip	:	33068-5210
Country	:	US
Telephone Number	:	305-709-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	6610 SW 18TH ST
Second Line	:
City	:	N LAUDERDALE
State	:	FL
Zip	:	33068-5210
Country	:	US
Telephone Number	:	305-709-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2017
Last Update Date	:	07/21/2022

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Directions to “ CHRISTINE' L DERICO ” Practice Location

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