Provider Demographics
NPI:1851789036
Name:GRANT-LOCKLEY, DAWN W (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:W
Last Name:GRANT-LOCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-7413
Mailing Address - Country:US
Mailing Address - Phone:203-675-4815
Mailing Address - Fax:
Practice Address - Street 1:157 CHURCH ST FL 19
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2100
Practice Address - Country:US
Practice Address - Phone:203-275-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical