DR. SAMUEL HICKSON (PHD, LCSW, NPT-C) – Clinical Social Worker, NPI 1083365589

DR. SAMUEL HICKSON (PHD, LCSW, NPT-C) is a healthcare provider. based in Las vegas, Nevada. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials PHD, LCSW, NPT-C. They hold a License No. 11811-C (NV). The NPI Number for DR. SAMUEL HICKSON (PHD, LCSW, NPT-C) is 1083365589

Main info

Male
Sole Proprietor
5 Years Of Experience
Accepts Medicare Assignment
Name
DR. SAMUEL HICKSON (PHD, LCSW, NPT-C)
NPI
1083365589
Phone
(702) 608-4220
Address
6885 W Charleston Blvd
Enumeration Date
16 January 2022
Last Update Date
30 April 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7026084220
Graduation Year
2021 (5 years ago)
PAC ID
0749711216
Group Practice PAC ID
5698076602
Professional Enrollment ID
I20241008002875
Address ID
NV891171600LA6885XBLVD400

Contacts

Other Endpoint
https://serenitysupportservices.com/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness85
Years active:4State licenses:1Other namesUpdated within 12 months

548 CLINICAL SOCIAL WORKER in NV

Provider Addresses for DR. SAMUEL HICKSON (PHD, LCSW, NPT-C)

  • 6885 W Charleston Blvd

    Las Vegas, NV 891171600

    Phone: (702) 608-4220

    Type: Location

  • 6879 W CHARLESTON BLVD STE A

    LAS VEGAS, NV 891171672

    Phone: (702) 608-4220

    Type: Location

  • 2480 W HORIZON RIDGE PKWY STE 100

    HENDERSON, NV 890522719

    Phone: (702) 608-4220

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-10-08

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241008002875IClinical Social WorkerNVTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 89117)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5698076602View full group profile
NameSpecialtyState
Mental Health CounselorNV
-NV
Clinical Social WorkerNV

Reviews

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Frequently asked questions

How do I look up DR. SAMUEL HICKSON (PHD, LCSW, NPT-C) by NPI?
Use NPI 1083365589 when you need to reference DR. SAMUEL HICKSON (PHD, LCSW, NPT-C) in forms, claims, or directories.
Is DR. SAMUEL HICKSON (PHD, LCSW, NPT-C)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What does DR. SAMUEL HICKSON (PHD, LCSW, NPT-C) treat or focus on?
Patients typically see DR. SAMUEL HICKSON (PHD, LCSW, NPT-C) under the specialty Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What location metadata exists for DR. SAMUEL HICKSON (PHD, LCSW, NPT-C)?
The page summarizes Las Vegas, Nevada for DR. SAMUEL HICKSON (PHD, LCSW, NPT-C); expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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