Provider Demographics
NPI:1437345840
Name:LOCKENBACH, BARRY RAY (LCSW)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:RAY
Last Name:LOCKENBACH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E NEW YORK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5568
Mailing Address - Country:US
Mailing Address - Phone:386-738-5543
Mailing Address - Fax:386-738-9821
Practice Address - Street 1:120 E NEW YORK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5568
Practice Address - Country:US
Practice Address - Phone:386-738-5543
Practice Address - Fax:386-738-9821
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL185911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical