Michael Jason Wickham, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

095201-01 Issued in NY

Practice address

146 Pike Street
Port Jervis, NY 12771-1939

Phone

(845) 858-1456

Fax

(845) 378-3283

NPI assigned

Mar 14, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1426291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1750774741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 GLENMERE AVE",
            "city": "FLORIDA",
            "state": "NY",
            "postal_code": "109211210",
            "telephone_number": "845-741-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 PIKE STREET",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127711939",
            "telephone_number": "845-858-1456",
            "fax_number": "845-378-3283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "MICHAEL",
        "middle_name": "JASON",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-14",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "257898",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "095201-01",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05923700",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Westchester County Health Care Corporation (Port Jervis Community Hospital, a member of WMCHealth)
• Westchester County Health Care Corporation (WMCHealth - St Joseph's)
• Amanda E Westfall, LCSW
• Whitney Rebecca White, DMD
• Lisa Whiteman, SOCIAL WORKER
• Robert Wilkins, M.D.
• William B Horn DDS PC (Aesthetic Family Dentistry)
• Clarise Denise Williams
• Annette Wilson, CASAC-T
• Kasey Wingerter, OTR/L

• Clinical Social Worker in Port Jervis, NY
• Providers in Port Jervis, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; 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.