Provider Demographics
NPI:1003873175
Name:HICKMAN, STEVEN DOUGLAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST ARBOR DRIVE
Mailing Address - Street 2:MC8218
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8218
Mailing Address - Country:US
Mailing Address - Phone:619-543-6470
Mailing Address - Fax:619-543-3738
Practice Address - Street 1:200 WEST ARBOR DRIVE
Practice Address - Street 2:MC8218
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8218
Practice Address - Country:US
Practice Address - Phone:619-543-6470
Practice Address - Fax:619-543-3738
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16677103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY166770Medicaid
CAPSY166770Medicaid
P11958Medicare UPIN