Healthcare Provider Details

I. General information

NPI: 1942402292
Provider Name (Legal Business Name): KATHLEEN MARIE HICKEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BELMONT ST 7C
WORCESTER MA
01604-1681
US

IV. Provider business mailing address

302 FOREST PARK DR #5
AUBURN MA
01501-5501
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-8751
  • Fax:
Mailing address:
  • Phone: 508-832-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1025398
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: