Active NPI
Elizabeth Brooke Hickman, LSW
- Social Worker
- Canton, OH
National Provider Identifier
1073850806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.1200974
- Practice address
- 624 Market Ave N
Canton, OH 44702-1017 - Phone
- (330) 454-7066
- NPI assigned
- Jan 14, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.1200974 | OH | Primary |
| Case Manager/Care Coordinator | 171M00000X | S.1200974 | OH |
Addresses
Primary practice location
624 Market Ave N
Canton, OH 44702-1017
Mailing address
624 Market Ave N
Canton, OH 44702-1017
Phone (330) 454-7066
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S.1200974 | Other | OH | COUNSELOR, SOCIAL WORKER AND MARRIAGE AND FAMILY THERAPIST BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.1200974 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358121600000",
"number": "1073850806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "624 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021017",
"telephone_number": "330-454-7066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "624 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021017",
"telephone_number": "330-454-7066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKMAN",
"first_name": "ELIZABETH",
"middle_name": "BROOKE",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-14",
"last_updated": "2013-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1200974",
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": "S.1200974",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNSELOR, SOCIAL WORKER AND MARRIAGE AND FAMILY THERAPIST BOARD",
"identifier": "S.1200974",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.