Provider Demographics
NPI:1356455505
Name:PICA, MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PICA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W222 LAFOX RD STE H1
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7631
Mailing Address - Country:US
Mailing Address - Phone:630-549-6497
Mailing Address - Fax:630-549-0942
Practice Address - Street 1:40W222 LAFOX RD STE H1
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7631
Practice Address - Country:US
Practice Address - Phone:630-549-6497
Practice Address - Fax:630-549-6497
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0032240595; 00445400OtherBC/BS PROVIDER NUMBER
ILUNITED HEALTHCAREOtherUNITED HEALTHCARE
ILAETNAOtherAETNA INSURANCE
ILHUMANAOtherHUMANA INSURANCE
ILUNITED HEALTHCAREOtherUNITED HEALTHCARE