Provider Demographics
NPI:1720101686
Name:LOCK, TIMOTHY G (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:LOCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 OLD NEW MILFORD RD
Mailing Address - Street 2:SUITE 2A - LANDMARK OFFICE CENTER
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2426
Mailing Address - Country:US
Mailing Address - Phone:203-775-3820
Mailing Address - Fax:203-775-3820
Practice Address - Street 1:2 OLD NEW MILFORD RD
Practice Address - Street 2:SUITE 2A - LANDMARK OFFICE CENTER
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-775-3820
Practice Address - Fax:203-775-3820
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002385103T00000X
NY014926103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002385CT01OtherANTHEM BLUE CROSS BLUE SH
CTP2534362OtherOXFORD HEALTH PLAN
CT250250OtherMHN HMC
CT2147508OtherCIGNA BEHAVIORAL HEALTH