Provider Demographics
NPI:1265857379
Name:HICKS, LAUREN PAMELA
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:PAMELA
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:PAMELA
Other - Last Name:D'ARRIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 FIRST AVENUE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-535-1213
Mailing Address - Fax:978-535-5510
Practice Address - Street 1:2 FIRST AVENUE
Practice Address - Street 2:SUITE 211
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-535-1213
Practice Address - Fax:978-535-5510
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist