Provider Demographics
NPI:1114986189
Name:LOCKWOOD, DIANNE SENTER (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:SENTER
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 JOHN ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2022
Mailing Address - Country:US
Mailing Address - Phone:508-243-5167
Mailing Address - Fax:508-224-4755
Practice Address - Street 1:59 SAMOSET ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4551
Practice Address - Country:US
Practice Address - Phone:508-747-2308
Practice Address - Fax:508-224-4755
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1851454Medicaid
62-23286OtherUNITED HEALTH CARE
MAPO1381OtherBLUE CROSS BLUE SHIELD
759807OtherTUFTS
759807OtherTUFTS