Provider Demographics
NPI:1184845117
Name:PICON, WILLIAM JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:PICON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 CHASE CROSSING CIRCLE
Mailing Address - Street 2:APT 403
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-9999
Mailing Address - Country:US
Mailing Address - Phone:301-335-9562
Mailing Address - Fax:
Practice Address - Street 1:7801 NORFOLK AVENUE
Practice Address - Street 2:SUITE 111
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-9999
Practice Address - Country:US
Practice Address - Phone:301-652-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1244103TC0700X, 103TC2200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD621256Medicare UPIN