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General NPI Number Information
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NPI Number | 1720418502
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Entity Type | Individual
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Provider Name | PATRICIA GRACE HICKEY MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 330 S FAIRMONT AVE STE 7
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City | LODI
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State | CA
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Zip | 95240-3843
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Country | US
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Telephone | 916-926-2372
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 521
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City | WOODBRIDGE
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State | CA
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Zip | 95258
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Country | US
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Telephone |
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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 | LCSW71406
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License Number State | CA
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