Healthcare Provider Details

I. General information

NPI: 1184836678
Provider Name (Legal Business Name): ROBERT ALAN WICKEY MSW, ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 LAFAYETTE RD #9
HAMPTON FALLS NH
03844
US

IV. Provider business mailing address

97 LAFAYETTE RD #9
HAMPTON FALLS NH
03844
US

V. Phone/Fax

Practice location:
  • Phone: 603-926-3556
  • Fax: 603-926-3556
Mailing address:
  • Phone: 603-926-3556
  • Fax: 603-926-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number567
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: