Provider Demographics
NPI:1083774855
Name:LOCKWOOD, KATHERYN POTENZA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERYN
Middle Name:POTENZA
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:JOANNA
Other - Last Name:POTENZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 5TH AVE
Mailing Address - Street 2:SUITE 704A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6510
Mailing Address - Country:US
Mailing Address - Phone:917-566-3614
Mailing Address - Fax:
Practice Address - Street 1:315 5TH AVE
Practice Address - Street 2:SUITE 704A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6510
Practice Address - Country:US
Practice Address - Phone:917-566-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0772961041C0700X
NY073947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical