Provider Demographics
NPI:1134221302
Name:HICKEY, JAMES J (LMSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:HICKEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2429
Mailing Address - Country:US
Mailing Address - Phone:917-623-9673
Mailing Address - Fax:
Practice Address - Street 1:98-120 QUEENS BLVD
Practice Address - Street 2:APT 1C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-830-0246
Practice Address - Fax:718-830-9088
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073507104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker