Provider Demographics
NPI:1255729257
Name:PICARD, ANDREA LYNN
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:PICARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 N AVONDALE AVE
Mailing Address - Street 2:203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1572
Mailing Address - Country:US
Mailing Address - Phone:773-774-4444
Mailing Address - Fax:773-774-4447
Practice Address - Street 1:6601 N AVONDALE AVE
Practice Address - Street 2:203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1572
Practice Address - Country:US
Practice Address - Phone:773-774-4444
Practice Address - Fax:773-774-4447
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008085101YP2500X
IL11-105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional