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General NPI Number Information
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NPI Number | 1821708074
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Entity Type | Individual
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Provider Name | GABRIELLE CLARE HICKEY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 157 E 86TH ST FL 5
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City | NEW YORK
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State | NY
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Zip | 10028-2113
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Country | US
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Telephone | 718-790-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 1058 GRAND BLVD
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City | WESTBURY
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State | NY
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Zip | 11590-5516
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Country | US
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Telephone | 516-445-5362
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 738097-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F404689-01
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License Number State | NY
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