Provider Demographics
NPI:1790762532
Name:BICKERTON, SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:BICKERTON
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 1:204 DEER CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3011
Mailing Address - Country:US
Mailing Address - Phone:512-346-2390
Mailing Address - Fax:512-344-9321
Practice Address - Street 1:204 DEER CREEK CIR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3011
Practice Address - Country:US
Practice Address - Phone:512-346-2390
Practice Address - Fax:512-344-9321
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9060Medicare PIN