MEDICARE: ELSA LOCKMAN LMSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1720666092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELSA LOCKMAN LMSW LLC

Provider Business Mailing Address
First Line	:	3551 MASON LAKE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9702
Country	:	US
Telephone Number	:	616-915-8324
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 MASON LAKE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9702
Country	:	US
Telephone Number	:	616-915-8324
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELSA LOCKMAN
Credential	:
Telephone Number	:	616-915-8324

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/30/2021

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Directions to “ELSA LOCKMAN LMSW LLC ” Practice Location

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