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General NPI Number Information
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NPI Number | 1578204350
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Entity Type | Individual
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Provider Name | JESSICA WICKI MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1158 WAYSIDE RD
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City | TINTON FALLS
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State | NJ
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Zip | 07712-3148
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Country | US
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Telephone | 732-493-1919
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Fax | 732-493-2413
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Provider Business Mailing Address
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Address Line | 73 VALLEY RD FL 2
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2210
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Country | US
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Telephone | 908-320-5320
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SC05951700
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License Number State | NJ
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