Provider Demographics
NPI:1194381988
Name:LOCKETT, TORI ASHLEY (MSW)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:ASHLEY
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:ASHLEY
Other - Last Name:PENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:225 N MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4993
Mailing Address - Country:US
Mailing Address - Phone:860-793-3875
Mailing Address - Fax:860-793-3369
Practice Address - Street 1:225 N MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4993
Practice Address - Country:US
Practice Address - Phone:860-793-3875
Practice Address - Fax:860-793-3369
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker