Individual
DR. KIMBERLY B DERRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1708 W ROGERS AVE, BALTIMORE, MD 21209-4545
(410) 578-8600
Mailing address
1708 W ROGERS AVE, BALTIMORE, MD 21209-4545
(410) 578-8600
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
03246
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199701700
—
MD
Enumeration date
11/08/2006
Last updated
07/08/2007
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