Provider Demographics
NPI:1295889533
Name:LOCKER, DAPHNA RONIT (PHD)
Entity type:Individual
Prefix:DR
First Name:DAPHNA
Middle Name:RONIT
Last Name:LOCKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 ACADEMY ST APT 6B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-4200
Mailing Address - Country:US
Mailing Address - Phone:646-734-9666
Mailing Address - Fax:
Practice Address - Street 1:675 ACADEMY ST APT 6B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4200
Practice Address - Country:US
Practice Address - Phone:646-734-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2655103T00000X
NY10775-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02265167Medicaid
NY02265167Medicaid
CO801215Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #