Healthcare Provider Details

I. General information

NPI: 1255545091
Provider Name (Legal Business Name): LEA LOCKWOOD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD STE A102
NORTH KINGSTOWN RI
02852-4128
US

IV. Provider business mailing address

1130 TEN ROD RD STE A102
NORTH KINGSTOWN RI
02852-4128
US

V. Phone/Fax

Practice location:
  • Phone: 401-445-2323
  • Fax: 401-429-6142
Mailing address:
  • Phone: 401-445-2323
  • Fax: 401-429-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01808
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: