Healthcare Provider Details

I. General information

NPI: 1801315833
Provider Name (Legal Business Name): REBECCA M HICKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WEST ST
CARTHAGE NY
13619-9703
US

IV. Provider business mailing address

482 BLACK RIVER PKWY
WATERTOWN NY
13601-2416
US

V. Phone/Fax

Practice location:
  • Phone: 315-493-3300
  • Fax:
Mailing address:
  • Phone: 315-782-1777
  • Fax: 315-785-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: