Provider Demographics
NPI:1265458665
Name:LOCKHART, JEFFREY H (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3591
Mailing Address - Country:US
Mailing Address - Phone:781-438-5550
Mailing Address - Fax:781-438-5553
Practice Address - Street 1:271 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3591
Practice Address - Country:US
Practice Address - Phone:781-438-5550
Practice Address - Fax:781-438-5553
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO2198Medicare UPIN
MAWO2198Medicare ID - Type Unspecified