MEDICARE: DR. TERRILYN ANDREA HICKMAN-ALLEN L.C.S.W.

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
1	1041C0700X	Clinical Social Worker	CW015044	PA
2	1041C0700X	Clinical Social Worker	Q1-0001094	DE

General Provider Information

NPI Number	:	1548476518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRILYN ANDREA HICKMAN-ALLEN L.C.S.W.

Provider Business Mailing Address
First Line	:	177 AMBERFIELD LN
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19702-4273
Country	:	US
Telephone Number	:	302-836-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 SPRING GARDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3936
Country	:	US
Telephone Number	:	215-751-8550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/21/2022

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