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General NPI Number Information
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NPI Number | 1124715529
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Entity Type | Individual
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Provider Name | TIMOTHY ROBERT HICKS MSW, ASW
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Gender | Male
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1849 SAWTELLE BLVD STE 610
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City | LOS ANGELES
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State | CA
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Zip | 90025-7013
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Country | US
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Telephone | 323-800-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 2455 BELLEVIEW RD
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City | UPLAND
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State | CA
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Zip | 91784-1194
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Country | US
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Telephone | 909-243-9881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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