Provider Demographics
NPI:1609910975
Name:HISCOX, SEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:HISCOX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N DOUGHTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1811
Mailing Address - Country:US
Mailing Address - Phone:980-526-1177
Mailing Address - Fax:
Practice Address - Street 1:25 N DOUGHTY AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1811
Practice Address - Country:US
Practice Address - Phone:980-526-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical