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NPI Code Detail

MEDICARE: TATIANA CHARLEA HICKS LCSW

MEDICARE: TATIANA CHARLEA HICKS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker136428CA

General Provider Information

NPI Number : 1326771932
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATIANA CHARLEA HICKS LCSW
Provider Business Mailing Address
First Line : 39159 PASEO PADRE PKWY STE 121
Second Line :
City : FREMONT
State : CA
Zip : 94538-1600
Country : US
Telephone Number : 510-952-1190
Fax Number : 510-972-5976
Provider Business Practice Location Address
First Line : 39159 PASEO PADRE PKWY STE 121
Second Line :
City : FREMONT
State : CA
Zip : 94538-1600
Country : US
Telephone Number : 510-952-1190
Fax Number : 510-972-5976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2022
Last Update Date : 01/13/2026

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