Provider Demographics
NPI:1528296597
Name:HICKEY, JACQUELIN ANN (BCBA)
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:ANN
Last Name:HICKEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 OSBORN ST
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1514
Mailing Address - Country:US
Mailing Address - Phone:732-264-1947
Mailing Address - Fax:
Practice Address - Street 1:37 OSBORN ST
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1514
Practice Address - Country:US
Practice Address - Phone:732-264-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYBCBA 1-03-1113103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst