National Provider Identifier Database

KELLY G EZICKSON, LICSW – NPI #1043284839
Social Worker

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.


Contact Information

KELLY G EZICKSON, LICSW
29 COTTAGE AVE SUITE 11
QUINCY, MA02169
Phone: 617-472-9838
Fax: 617-472-6269
Website:
Specialty Taxonomy Code
* Social Worker 104100000X

* Indicates primary specialty

NPI Profile & details for KELLY G EZICKSON

NPI Number 1043284839
Credentials LICSW (Licensed Independent Clinical Social Worker)
Entity Individual
Enumeration date 02/16/2006
Last updated 07/09/2007 - About 19 years ago
Sole proprietor1 Not specified
Identifiers
  • MA License #: 1020756
  • MA Medicaid: RA P30158
  • MA Other: P06289 BCBS
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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