Healthcare Provider Details

I. General information

NPI: 1841573656
Provider Name (Legal Business Name): RICHARD E HOCKETT JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N COUNTY FARM RD
WHEATON IL
60187-3977
US

IV. Provider business mailing address

111 N COUNTY FARM RD
WHEATON IL
60187-3977
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7979
  • Fax:
Mailing address:
  • Phone: 630-682-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: