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NPI Code Detail

MEDICARE: MR. RANDALL BLAIR HICKS PSYD

MEDICARE: MR. RANDALL BLAIR HICKS PSYD
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
1103TC0700XClinical PsychologistPS015295PA

General Provider Information

NPI Number : 1699983940
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL BLAIR HICKS PSYD
Provider Business Mailing Address
First Line : 22 SOUTH STATE STREET
Second Line :
City : NEWTOWN
State : PA
Zip : 18940-3507
Country : US
Telephone Number : 215-579-4116
Fax Number :
Provider Business Practice Location Address
First Line : 22 SOUTH STATE STREET
Second Line :
City : NEWTOWN
State : PA
Zip : 18940-3507
Country : US
Telephone Number : 215-579-4116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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