Provider Demographics
NPI:1720546385
Name:LOCUS, SADIQ
Entity Type:Individual
Prefix:
First Name:SADIQ
Middle Name:
Last Name:LOCUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20503
Mailing Address - Street 2:
Mailing Address - City:LEHIGH VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18002-0503
Mailing Address - Country:US
Mailing Address - Phone:484-335-6100
Mailing Address - Fax:484-335-6104
Practice Address - Street 1:600 N JACKSON ST STE 203
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2574
Practice Address - Country:US
Practice Address - Phone:484-444-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-19-35788103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1-19-35788OtherBACB
RBT-15-03063OtherBACB REGISTRATION NUMBER