Provider Demographics
NPI:1588617369
Name:LOCK, CYNTHIA A SR (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:LOCK
Suffix:SR
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20290 DRUMMOND BAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1467
Mailing Address - Country:US
Mailing Address - Phone:586-823-0339
Mailing Address - Fax:
Practice Address - Street 1:32743 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1985
Practice Address - Country:US
Practice Address - Phone:586-716-0980
Practice Address - Fax:586-716-0985
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801061796104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0961440Medicare ID - Type UnspecifiedMEDICARE NUMBER