Provider Demographics
NPI:1699824458
Name:BICKNELL, R. STUART (EDD)
Entity type:Individual
Prefix:
First Name:R. STUART
Middle Name:
Last Name:BICKNELL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3016
Mailing Address - Country:US
Mailing Address - Phone:413-256-4669
Mailing Address - Fax:
Practice Address - Street 1:394 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-3016
Practice Address - Country:US
Practice Address - Phone:413-256-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2646103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling