Provider Demographics
NPI:1447942297
Name:O'CONNOR HICKS, SHANNON NOELLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NOELLE
Last Name:O'CONNOR HICKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2259 35TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2206
Mailing Address - Country:US
Mailing Address - Phone:914-582-0295
Mailing Address - Fax:
Practice Address - Street 1:423 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5011
Practice Address - Country:US
Practice Address - Phone:914-582-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker