Healthcare Provider Details

I. General information

NPI: 1942851944
Provider Name (Legal Business Name): CARLY ANNE LOCKOWITZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 BERKSHIRE BLVD STE 100
WYOMISSING PA
19610-1222
US

IV. Provider business mailing address

1105 BERKSHIRE BLVD STE 100
WYOMISSING PA
19610-1222
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-4963
  • Fax:
Mailing address:
  • Phone: 610-374-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136558
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: