Provider Demographics
NPI:1487079638
Name:HICKS, VICTORIA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WASHINGTON ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1805
Mailing Address - Country:US
Mailing Address - Phone:888-970-3827
Mailing Address - Fax:
Practice Address - Street 1:40 WASHINGTON ST
Practice Address - Street 2:SUITE 240
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1805
Practice Address - Country:US
Practice Address - Phone:888-970-3827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor