Provider Demographics
NPI:1063660512
Name:HICKMAN, WILLIAM ARTHUR (CASAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:ARTHUR
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC
Mailing Address - Street 1:148 BAY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2503
Mailing Address - Country:US
Mailing Address - Phone:718-981-7861
Mailing Address - Fax:718-981-7861
Practice Address - Street 1:148 BAY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2503
Practice Address - Country:US
Practice Address - Phone:718-981-7861
Practice Address - Fax:718-981-7861
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11232101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)