Healthcare Provider Details

I. General information

NPI: 1801837448
Provider Name (Legal Business Name): CHARLES DRAVO LOVELOCK L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLES DRAVO LOVELOCK L.C.S.W.

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3584 JEROME AVE
BRONX NY
10467-1052
US

IV. Provider business mailing address

PO BOX 31094
HARTFORD CT
06150-1094
US

V. Phone/Fax

Practice location:
  • Phone: 718-653-1537
  • Fax: 718-882-1426
Mailing address:
  • Phone: 800-989-6446
  • Fax: 518-952-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: