Healthcare Provider Details

I. General information

NPI: 1780697995
Provider Name (Legal Business Name): AMY V CAHILL HICKEY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE VA BOSTON HCS SOCIAL WORK SERVICE (122)
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE VA BOSTON HCS SOCIAL WORK SERVICE (122)
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-4394
  • Fax: 857-364-2957
Mailing address:
  • Phone: 857-364-4394
  • Fax: 857-364-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113355
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: