Healthcare Provider Details

I. General information

NPI: 1881063360
Provider Name (Legal Business Name): JAMES LEE HICKSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WINFIELD ST
WORCESTER MA
01602-3461
US

IV. Provider business mailing address

57 PINE ST
LEICESTER MA
01524-1615
US

V. Phone/Fax

Practice location:
  • Phone: 508-981-1772
  • Fax:
Mailing address:
  • Phone: 508-981-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2130715
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: