Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Michael Jason Wickham, LCSW

Individual provider Clinical Social Worker · NPI 1750774741

Michael Jason Wickham, LCSW is a Clinical Social Worker in Port Jervis, New York. Practices as a sole proprietor. Licensed in Kentucky, New Jersey and New York.

Licensed in
KY, NJ, NY
In the registry since
2015
Specialties on file
3
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

See every abbreviation used in this directory →

Practice location Address checks out

146 Pike St
Port Jervis, NY 12771-1939
Phone: (845) 858-1456
Fax: (845) 378-3283
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 095201-01 (NY)
Clinical Social Worker Taxonomy 1041C0700X · Licence 257898 (KY)
Clinical Social Worker Taxonomy 1041C0700X · Licence 44SC05923700 (NJ)

Record details

NPI number1750774741
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedMarch 14, 2015
Last updated in NPPESJuly 22, 2026
Certification dateJuly 22, 2026

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