Provider Demographics
NPI:1932685336
Name:LOCKHART, SAMANTHA JO (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SADLER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5321
Mailing Address - Country:US
Mailing Address - Phone:201-655-2126
Mailing Address - Fax:
Practice Address - Street 1:138 SADLER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5321
Practice Address - Country:US
Practice Address - Phone:201-655-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst