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General NPI Number Information
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NPI Number | 1720101686
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Entity Type | Individual
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Provider Name | TIMOTHY G. LOCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2 OLD NEW MILFORD RD SUITE 2A - LANDMARK OFFICE CENTER
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City | BROOKFIELD
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State | CT
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Zip | 06804-2426
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Country | US
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Telephone | 203-775-3820
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Fax | 203-775-3820
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Provider Business Mailing Address
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Address Line | 2 OLD NEW MILFORD RD SUITE 2A - LANDMARK OFFICE CENTER
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City | BROOKFIELD
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State | CT
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Zip | 06804-2426
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Country | US
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Telephone | 203-775-3820
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Fax | 203-775-3820
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002385
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 014926
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License Number State | NY
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