Healthcare Provider Details

I. General information

NPI: 1134221302
Provider Name (Legal Business Name): JAMES J. HICKEY LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-120 QUEENS BLVD APT 1C
REGO PARK NY
11374
US

IV. Provider business mailing address

79 MONTE VISTA AVE
RIDGEWOOD NJ
07450-2429
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax: 718-830-9088
Mailing address:
  • Phone: 917-623-9673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number073507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: