Active NPI
Heather Derry Vick, PHD
- Clinical Psychologist
- Brooklyn, NY
National Provider Identifier
1366907818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 023019-1
- Practice address
- 3512 Quentin Rd Ste 110
Brooklyn, NY 11234-4245 - Phone
- (718) 854-8370
- NPI assigned
- Feb 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 023019-1 | NY | Primary |
Addresses
Primary practice location
3512 Quentin Rd Ste 110
Brooklyn, NY 11234-4245
Mailing address
48 47TH St Apt 1
Weehawken, NJ 07086-7154
Phone (412) 554-0120
Other names 1
- Heather Derry
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023019-1 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549584000000",
"number": "1366907818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 47TH ST APT 1",
"city": "WEEHAWKEN",
"state": "NJ",
"postal_code": "070867154",
"telephone_number": "412-554-0120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3512 QUENTIN RD STE 110",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112344245",
"telephone_number": "718-854-8370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERRY VICK",
"first_name": "HEATHER",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-08",
"last_updated": "2019-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "023019-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HEATHER",
"last_name": "DERRY",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.