Provider Demographics
NPI:1063075778
Name:LOCKETT, CYNTHIA OPHELIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:OPHELIA
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-3160
Mailing Address - Country:US
Mailing Address - Phone:412-378-0591
Mailing Address - Fax:
Practice Address - Street 1:112 WASHINGTON PL STE 1M
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-3424
Practice Address - Country:US
Practice Address - Phone:412-256-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker