Provider Demographics
NPI:1326300062
Name:HICKS, TIFFANY (MSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 SAWTELLE BLVD
Mailing Address - Street 2:APT D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066
Mailing Address - Country:US
Mailing Address - Phone:626-922-2477
Mailing Address - Fax:
Practice Address - Street 1:3967 SAWTELLE BLVD
Practice Address - Street 2:APT D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5042
Practice Address - Country:US
Practice Address - Phone:626-922-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32907104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker