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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 Specialty Code Provider Type

Social Worker

104100000X
Indicates primary specialty

NPI Profile & details for KELLY G EZICKSON · (Female)

NPI Number 1043284839
Status Active
Credentials LICSW (Licensed Independent Clinical Social Worker)
Entity Individual
Enumeration date 02/16/2006
Last updated 07/09/2007 - About 19 years ago
Sole proprietor 1 Not specified
Identifiers
  • MA License # 1020756
  • MA Medicaid RA P30158
  • MA Other P06289 BCBS
Hospital affiliation(s) Not Available
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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