Provider Demographics
NPI:1245469303
Name:PAULA LOCKE, LCSW, CAP, PA
Entity type:Organization
Organization Name:PAULA LOCKE, LCSW, CAP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:N
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:754-204-0312
Mailing Address - Street 1:9470 LIVE OAK PL
Mailing Address - Street 2:SUITE 405
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4769
Mailing Address - Country:US
Mailing Address - Phone:754-204-0312
Mailing Address - Fax:954-302-1830
Practice Address - Street 1:4699 N STATE ROAD 7
Practice Address - Street 2:SUITE P
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5879
Practice Address - Country:US
Practice Address - Phone:954-234-2724
Practice Address - Fax:954-302-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL761451900171M00000X
FL101YA0400X, 171M00000X, 172V00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001314200Medicaid
FL761451900Medicaid
FL002968700Medicaid
FL001867700Medicaid
FLDJ386AOtherMEDICARE PTAN