Provider Demographics
NPI:1407919426
Name:HICKS, ELAINE K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:K
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 TAMARACK CIR
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2019
Mailing Address - Country:US
Mailing Address - Phone:609-497-2464
Mailing Address - Fax:609-497-3466
Practice Address - Street 1:2 CAMELIA CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3202
Practice Address - Country:US
Practice Address - Phone:609-497-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00531700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health