Provider Demographics
NPI:1598174526
Name:HICKEY, PATRICIA BARR
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:BARR
Last Name:HICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KEARNEY PL
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2500
Mailing Address - Country:US
Mailing Address - Phone:484-483-9764
Mailing Address - Fax:
Practice Address - Street 1:112 KEARNEY PL
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2500
Practice Address - Country:US
Practice Address - Phone:484-483-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000318103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst