Provider Demographics
NPI:1427352020
Name:HICKMAN, UTE (LAC)
Entity type:Individual
Prefix:MRS
First Name:UTE
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 NORTHFIELD ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4645
Mailing Address - Country:US
Mailing Address - Phone:203-570-5832
Mailing Address - Fax:
Practice Address - Street 1:13-15 NEPERAN RD
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3446
Practice Address - Country:US
Practice Address - Phone:914-631-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3451171100000X
CT403171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist