MEDICARE: PATRICIA LOCKHART MSW LCSW

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	P009584	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201FM	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1780050450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LOCKHART MSW LCSW

Provider Business Mailing Address
First Line	:	4724 PARK RD STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-4204
Country	:	US
Telephone Number	:	704-218-9083
Fax Number	:	980-237-7512

Provider Business Practice Location Address
First Line	:	4724 PARK RD STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-4204
Country	:	US
Telephone Number	:	704-218-9083
Fax Number	:	980-237-7512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	10/01/2021

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