Wickham, Michael Jason

Wickham, Michael Jason is an sole proprietor health care provider with primary practice located at 146 Pike Street , Port Jervis NY 12771-1939. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Wickham, Michael Jason can be contacted via phone (845) 858-1456.

Contact Information

Primary practice address
146 Pike Street Port Jervis NY 12771-1939
Phone: (845) 858-1456
Fax: (845) 378-3283
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 257898 Kentucky
Behavioral Health & Social Service Providers / Clinical 1041C0700X 095201-01 New York
Behavioral Health & Social Service Providers / Clinical 1041C0700X 44SC05923700 New Jersey

Profile Details

NPI number 1750774741
LBN Legal business name Wickham, Michael Jason
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 14th, 2015
Last updated Jul 22nd, 2026 - about 3 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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