Provider Demographics
NPI:1003958992
Name:HICKOK, MARY HASTY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARY HASTY
Middle Name:
Last Name:HICKOK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:HASTY
Other - Middle Name:
Other - Last Name:HICKOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:62 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-9726
Mailing Address - Country:US
Mailing Address - Phone:413-348-8275
Mailing Address - Fax:413-582-6956
Practice Address - Street 1:62 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MA
Practice Address - Zip Code:01096-9726
Practice Address - Country:US
Practice Address - Phone:413-348-8275
Practice Address - Fax:413-582-6956
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1039621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1893076OtherBC
MA249652OtherMAGELLAN
MA1893076OtherMBHP
MA249652OtherMAGELLAN