Provider Demographics
NPI:1801837448
Name:LOVELOCK, CHARLES DRAVO (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DRAVO
Last Name:LOVELOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:DRAVO
Other - Last Name:LOVELOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 31094
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-1094
Mailing Address - Country:US
Mailing Address - Phone:800-989-6446
Mailing Address - Fax:518-952-8287
Practice Address - Street 1:3584 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1052
Practice Address - Country:US
Practice Address - Phone:718-653-1537
Practice Address - Fax:718-882-1426
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0723941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420795Medicaid
NY01420795Medicaid