Provider Demographics
NPI:1396291225
Name:LOCKE, CAROL ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:840 S RANCHO DR
Mailing Address - Street 2:APT 4-618
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:786-498-9268
Mailing Address - Fax:305-503-9499
Practice Address - Street 1:19675 7TH ST E
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7202
Practice Address - Country:US
Practice Address - Phone:786-498-9268
Practice Address - Fax:305-503-9499
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG732212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry