Provider Demographics
NPI:1952584195
Name:HICKS, REBECCA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:45 NEWBURY ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3133
Mailing Address - Country:US
Mailing Address - Phone:857-263-8673
Mailing Address - Fax:857-263-8642
Practice Address - Street 1:45 NEWBURY ST
Practice Address - Street 2:SUITE 505
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3133
Practice Address - Country:US
Practice Address - Phone:857-263-8673
Practice Address - Fax:857-263-8642
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2573242084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry