Provider Demographics
NPI:1427316090
Name:HICKS, LENWOOD L
Entity type:Individual
Prefix:
First Name:LENWOOD
Middle Name:L
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CLASSON AVE
Mailing Address - Street 2:ROOM 131
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1006
Mailing Address - Country:US
Mailing Address - Phone:718-636-4900
Mailing Address - Fax:718-857-3688
Practice Address - Street 1:901 CLASSON AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1006
Practice Address - Country:US
Practice Address - Phone:718-636-4900
Practice Address - Fax:718-857-3688
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002771-1174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator