Provider Demographics
NPI:1255372702
Name:HICKS, CAROLYN F (EDD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:F
Last Name:HICKS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HARLOW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4211
Mailing Address - Country:US
Mailing Address - Phone:413-584-9480
Mailing Address - Fax:
Practice Address - Street 1:43 CENTER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3063
Practice Address - Country:US
Practice Address - Phone:413-584-9480
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W03415Medicare ID - Type Unspecified