Healthcare Provider Details

I. General information

NPI: 1760948145
Provider Name (Legal Business Name): VICTORIA L LOCKWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 GLENSPRINGS DR STE 201
CINCINNATI OH
45246-2353
US

IV. Provider business mailing address

415 GLENSPRINGS DR STE 201
CINCINNATI OH
45246-2353
US

V. Phone/Fax

Practice location:
  • Phone: 513-771-9600
  • Fax: 513-771-2546
Mailing address:
  • Phone: 513-771-9600
  • Fax: 513-771-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005548
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: