MEDICARE: DR. ANGELA KATHERINE PICOT DERRICK PH.D.

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	103TC0700X	Clinical Psychologist	071-007116	IL

General Provider Information

NPI Number	:	1659599009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA KATHERINE PICOT DERRICK PH.D.

Provider Business Mailing Address
First Line	:	655 W IRVING PARK RD
Second Line	:	#2317
City	:	CHICAGO
State	:	IL
Zip	:	60613-3123
Country	:	US
Telephone Number	:	773-578-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 520
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3433
Country	:	US
Telephone Number	:	773-578-7406
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/26/2025

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