Provider Demographics
NPI:1679157374
Name:HICKMAN, JENNIFER KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:708 FOOTE AVE # 289
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-8225
Mailing Address - Country:US
Mailing Address - Phone:716-980-7850
Mailing Address - Fax:716-427-0423
Practice Address - Street 1:42 DUNHAM AVE OFC 4
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2514
Practice Address - Country:US
Practice Address - Phone:716-980-7850
Practice Address - Fax:716-427-0423
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0975871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical