Active NPI
Walter R. Hickey, LCSW
- Clinical Social Worker
- Santa Rosa, CA
National Provider Identifier
1841477304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS12154
- Practice address
- 3317 Chanate Rd
Santa Rosa, CA 95404-1737 - Phone
- (707) 570-3882
- NPI assigned
- Jan 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS12154 | CA | Primary |
Addresses
Primary practice location
3317 Chanate Rd
Santa Rosa, CA 95404-1737
Mailing address
3317 Chanate Rd
Santa Rosa, CA 95404-1737
Phone (707) 570-3882
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 |
|---|---|---|---|
| LCS12154 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1841477304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3317 CHANATE RD",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954041737",
"telephone_number": "707-570-3882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3317 CHANATE RD",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954041737",
"telephone_number": "707-570-3882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKEY",
"first_name": "WALTER",
"middle_name": "R.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-28",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS12154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.