Provider Demographics
NPI:1033240080
Name:HICKS, MATTHEW RONALD (LCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RONALD
Last Name:HICKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24885 WHITEWOOD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2004
Mailing Address - Country:US
Mailing Address - Phone:626-712-1865
Mailing Address - Fax:
Practice Address - Street 1:24885 WHITEWOOD RD STE 105
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2004
Practice Address - Country:US
Practice Address - Phone:626-712-1865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211321041C0700X
CALCS211321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical