Provider Demographics
NPI:1801089149
Name:HICKEY, CARL HERBERT JR (LICSW)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:HERBERT
Last Name:HICKEY
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 MORPHY AVE
Mailing Address - Street 2:ATTN: THE HARBOR AT THOMAS HOSPITAL
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1812
Mailing Address - Country:US
Mailing Address - Phone:251-279-1119
Mailing Address - Fax:251-279-1117
Practice Address - Street 1:750 MORPHY AVE
Practice Address - Street 2:ATTN: THE HARBOR AT THOMAS HOSPITAL
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1812
Practice Address - Country:US
Practice Address - Phone:251-279-1119
Practice Address - Fax:251-279-1117
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0958C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554978Medicare PIN
R77261Medicare UPIN