Provider Demographics
NPI:1124795745
Name:HICKEY-SMITH, AMY (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HICKEY-SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:75 SHAFTSBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2140
Mailing Address - Country:US
Mailing Address - Phone:585-623-0178
Mailing Address - Fax:
Practice Address - Street 1:75 SHAFTSBURY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-2140
Practice Address - Country:US
Practice Address - Phone:585-623-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110735-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker