Provider Demographics
NPI:1164575130
Name:LOCKWOOD, MICHELLE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:J
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:PSYD
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:339-933-1184
Mailing Address - Fax:
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:781-248-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist