Provider Demographics
NPI:1083957955
Name:HICKEY, PHILIP A IV (MSW/LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:A
Last Name:HICKEY
Suffix:IV
Gender:M
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 UNION ST
Mailing Address - Street 2:APT. B1
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3369
Mailing Address - Country:US
Mailing Address - Phone:973-619-2064
Mailing Address - Fax:
Practice Address - Street 1:2100 CORLIES AVENUE
Practice Address - Street 2:SUITE 14
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:973-619-2064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055268001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical