Provider Demographics
NPI:1801903471
Name:HICKLING, EDWARD JAMES (PSYD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:HICKLING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ATRIUM DR STE 240
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1441
Mailing Address - Country:US
Mailing Address - Phone:518-453-9220
Mailing Address - Fax:518-453-2326
Practice Address - Street 1:4 ATRIUM DR STE 240
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1441
Practice Address - Country:US
Practice Address - Phone:518-453-9220
Practice Address - Fax:518-453-2326
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077701103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0651Medicare ID - Type Unspecified