Provider Demographics
NPI:1376306860
Name:LOCKSHIN, ROMAN (RMHCI, MA, MBA)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:LOCKSHIN
Suffix:
Gender:M
Credentials:RMHCI, MA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2699 STIRLING RD STE C403A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6564
Mailing Address - Country:US
Mailing Address - Phone:954-707-1824
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING RD STE C403A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6564
Practice Address - Country:US
Practice Address - Phone:954-707-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health