Provider Demographics
NPI:1518059187
Name:LOCKE, SUSAN SHERLOCK (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SHERLOCK
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6133 ROCKSIDE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2223
Mailing Address - Country:US
Mailing Address - Phone:216-520-5969
Mailing Address - Fax:216-520-5098
Practice Address - Street 1:6133 ROCKSIDE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2223
Practice Address - Country:US
Practice Address - Phone:216-520-5969
Practice Address - Fax:216-520-5098
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH549612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry