Provider Demographics
NPI:1205554227
Name:LOCKE, LATOYA (LSW)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 STONERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HELMETTA
Mailing Address - State:NJ
Mailing Address - Zip Code:08828-1141
Mailing Address - Country:US
Mailing Address - Phone:172-473-4357
Mailing Address - Fax:
Practice Address - Street 1:595 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4158
Practice Address - Country:US
Practice Address - Phone:732-675-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06808200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker