Healthcare Provider Details

I. General information

NPI: 1679117808
Provider Name (Legal Business Name): CHRISTINE HICKEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE PERRAULT RN

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WINTER ST
PEMBROKE MA
02359-4965
US

IV. Provider business mailing address

20 WINTER ST STE 2
PEMBROKE MA
02359-4965
US

V. Phone/Fax

Practice location:
  • Phone: 781-312-1393
  • Fax:
Mailing address:
  • Phone: 781-312-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2324899
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: