Healthcare Provider Details

I. General information

NPI: 1245469303
Provider Name (Legal Business Name): PAULA LOCKE, LCSW, CAP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4699 N STATE ROAD 7 SUITE P
LAUDERDALE LAKES FL
33319-5879
US

IV. Provider business mailing address

9470 LIVE OAK PL SUITE 405
DAVIE FL
33324-4769
US

V. Phone/Fax

Practice location:
  • Phone: 954-234-2724
  • Fax: 954-302-1830
Mailing address:
  • Phone: 754-204-0312
  • Fax: 954-302-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number761451900
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. PAULA N LOCKE
Title or Position: LICENSE CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 754-204-0312