Provider Demographics
NPI:1790435618
Name:LOCKWOOD, SAMANTHA E
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 DEL NORTE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8368
Mailing Address - Country:US
Mailing Address - Phone:805-302-1375
Mailing Address - Fax:
Practice Address - Street 1:1317 DEL NORTE RD STE 200
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8368
Practice Address - Country:US
Practice Address - Phone:805-302-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)