Provider Demographics
NPI:1457824138
Name:LOCK, ROXANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:LOCK
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 1:31 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2319
Mailing Address - Country:US
Mailing Address - Phone:973-477-0438
Mailing Address - Fax:
Practice Address - Street 1:31 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2319
Practice Address - Country:US
Practice Address - Phone:973-477-0438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0867351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical