Provider Demographics
NPI:1760525109
Name:LOCY, WILLIAM A (EDD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:LOCY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 FILLMORE ST
Mailing Address - Street 2:STE 410
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1514
Mailing Address - Country:US
Mailing Address - Phone:303-333-4559
Mailing Address - Fax:303-333-0057
Practice Address - Street 1:1633 FILLMORE ST
Practice Address - Street 2:STE 410
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1514
Practice Address - Country:US
Practice Address - Phone:303-333-4559
Practice Address - Fax:303-333-0057
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1659103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017091Medicaid
CO07101504Medicaid
CO04017091Medicaid
CO804532Medicare ID - Type UnspecifiedMEDICARE ID NUMBER