Provider Demographics
NPI:1851439442
Name:LOCKE, ROBERTA SUE (MSW,LSW,BCD)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:SUE
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MSW,LSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PHEASANT RUN DR
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-2049
Mailing Address - Country:US
Mailing Address - Phone:610-296-9776
Mailing Address - Fax:
Practice Address - Street 1:313 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4908
Practice Address - Country:US
Practice Address - Phone:215-732-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW0028086L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA640417Medicare UPIN