Provider Demographics
NPI:1184836678
Name:WICKEY, ROBERT ALAN (MSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:WICKEY
Suffix:
Gender:M
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 LAFAYETTE RD
Mailing Address - Street 2:#9
Mailing Address - City:HAMPTON FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03844
Mailing Address - Country:US
Mailing Address - Phone:603-926-3556
Mailing Address - Fax:603-926-3556
Practice Address - Street 1:97 LAFAYETTE RD
Practice Address - Street 2:#9
Practice Address - City:HAMPTON FALLS
Practice Address - State:NH
Practice Address - Zip Code:03844
Practice Address - Country:US
Practice Address - Phone:603-926-3556
Practice Address - Fax:603-926-3556
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007378Medicaid
NH1408998Y0NH01OtherBLUE CROSS
NHRE3459Medicare ID - Type Unspecified