Provider Demographics
NPI:1932497989
Name:LOCKE, BRITTANY LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEIGH
Last Name:LOCKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:LEIGH
Other - Last Name:BOISVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:50 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1536
Mailing Address - Country:US
Mailing Address - Phone:800-434-3000
Mailing Address - Fax:207-294-4649
Practice Address - Street 1:1486 BROADWAY
Practice Address - Street 2:UNIT B
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2602
Practice Address - Country:US
Practice Address - Phone:207-200-1373
Practice Address - Fax:866-861-9126
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC141491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102010102Medicaid
ME102010102Medicaid
MEMM8541Medicare PIN