Jeremiah Wayne Hicks, LCSW, CAADC, CCDPD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW017437 Issued in PA

Practice address

1993 Cato Ave
State College, PA 16801-2754

Phone

(814) 231-8820

Fax

(814) 231-8857

NPI assigned

Jan 11, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508284800000",
    "number": "1477890382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1993 CATO AVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168012754",
            "telephone_number": "814-231-8820",
            "fax_number": "814-231-8857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1993 CATO AVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168012754",
            "telephone_number": "814-231-8820",
            "fax_number": "814-231-8857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "JEREMIAH",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "LCSW, CAADC, CCDPD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-11",
        "last_updated": "2017-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW017437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in State College, PA
• Providers in State College, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.