Healthcare Provider Details

I. General information

NPI: 1366733248
Provider Name (Legal Business Name): NAOMI HICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 NW 2ND AVE PH 5
MIAMI GARDENS FL
33169-4524
US

IV. Provider business mailing address

9201 KENSINGTON ROW CT
ORLANDO FL
32827-5757
US

V. Phone/Fax

Practice location:
  • Phone: 954-257-7473
  • Fax:
Mailing address:
  • Phone: 561-329-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: