Provider Demographics
NPI:1144357609
Name:RANDALL-HICKS, ROSE (LICSW)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:RANDALL-HICKS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 DRAPER AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-5047
Mailing Address - Country:US
Mailing Address - Phone:401-732-5200
Mailing Address - Fax:401-737-2302
Practice Address - Street 1:160 DRAPER AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-5047
Practice Address - Country:US
Practice Address - Phone:401-732-5200
Practice Address - Fax:401-737-2302
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW005001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical