Provider Demographics
NPI:1760457402
Name:HICKS, SUSAN JILL (MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JILL
Last Name:HICKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 NEELY ROAD
Mailing Address - Street 2:
Mailing Address - City:JBMDL
Mailing Address - State:NJ
Mailing Address - Zip Code:08641-2234
Mailing Address - Country:US
Mailing Address - Phone:609-754-9324
Mailing Address - Fax:
Practice Address - Street 1:3458 NEELY RD
Practice Address - Street 2:
Practice Address - City:JB MDL
Practice Address - State:NJ
Practice Address - Zip Code:08641-5312
Practice Address - Country:US
Practice Address - Phone:609-754-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health