Provider Demographics
NPI:1336221522
Name:HERTZLIN-LOCKAMYEIR, ANNETTE MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MARIE
Last Name:HERTZLIN-LOCKAMYEIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:MARIE
Other - Last Name:LOCKAMYEIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:117 DELAINA ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9344
Mailing Address - Country:US
Mailing Address - Phone:585-303-3724
Mailing Address - Fax:
Practice Address - Street 1:27 S PLATT ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1431
Practice Address - Country:US
Practice Address - Phone:585-303-3724
Practice Address - Fax:585-589-1036
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069241-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02432180Medicaid
NY02432180Medicaid