Provider Demographics
NPI:1588779250
Name:LOCKWOOD, BRIENNE N (MSW)
Entity type:Individual
Prefix:MRS
First Name:BRIENNE
Middle Name:N
Last Name:LOCKWOOD
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 1:1013 HOLLYCREST DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-4205
Mailing Address - Country:US
Mailing Address - Phone:217-390-8847
Mailing Address - Fax:
Practice Address - Street 1:1002 S RACE ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4957
Practice Address - Country:US
Practice Address - Phone:217-239-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker