Provider Demographics
NPI:1881132835
Name:HICKOX, RHIANNON SAMANTHA (LCSW)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:SAMANTHA
Last Name:HICKOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1812
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:7980 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2536
Practice Address - Country:US
Practice Address - Phone:315-624-8440
Practice Address - Fax:315-624-8450
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090453-011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06449123Medicaid