Active NPI
Kimberly B Derrickson, PHD
- Clinical Child & Adolescent Psychologist
- Baltimore, MD
National Provider Identifier
1467522540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 03246
- Practice address
- 1708 W Rogers Ave
Baltimore, MD 21209-4545 - Phone
- (410) 578-8600
- NPI assigned
- Nov 8, 2006
- 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 Child & Adolescent Psychologist | 103TC2200X | 03246 | MD | Primary |
Addresses
Primary practice location
1708 W Rogers Ave
Baltimore, MD 21209-4545
Mailing address
1708 W Rogers Ave
Baltimore, MD 21209-4545
Phone (410) 578-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 199701700 | Medicaid | MD |
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 |
|---|---|---|---|
| 03246 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467522540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 W ROGERS AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212094545",
"telephone_number": "410-578-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 W ROGERS AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212094545",
"telephone_number": "410-578-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERRICKSON",
"first_name": "KIMBERLY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MD",
"license": "03246",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "199701700",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.