Provider Demographics
NPI:1427169820
Name:LOCKWOOD-CONLAN, BEVERLY (MSW)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:LOCKWOOD-CONLAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3624
Mailing Address - Country:US
Mailing Address - Phone:818-956-0101
Mailing Address - Fax:818-956-1413
Practice Address - Street 1:6425 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3624
Practice Address - Country:US
Practice Address - Phone:818-956-0101
Practice Address - Fax:818-956-1413
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS61481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS25029Medicare UPIN