Provider Demographics
NPI:1215660857
Name:HICKMAN, JAYDE ELYSSE (MSW)
Entity type:Individual
Prefix:MISS
First Name:JAYDE
Middle Name:ELYSSE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 HANY LN
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2740
Mailing Address - Country:US
Mailing Address - Phone:860-817-9701
Mailing Address - Fax:
Practice Address - Street 1:275 HANY LN
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-2740
Practice Address - Country:US
Practice Address - Phone:860-817-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker