Provider Demographics
NPI:1093011975
Name:LOCKWOOD, LAURA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DENISE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 46TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-1718
Mailing Address - Country:US
Mailing Address - Phone:505-500-4282
Mailing Address - Fax:
Practice Address - Street 1:2041 46TH ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-1718
Practice Address - Country:US
Practice Address - Phone:505-500-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS09009641041C0700X
NMC-110961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0245736Medicaid