Provider Demographics
NPI:1699965996
Name:SANTORSOLA LOCKEY, MINA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:M
Last Name:SANTORSOLA LOCKEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MINA
Other - Middle Name:M
Other - Last Name:SANTORSOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4760 E GALBRAITH RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6704
Mailing Address - Country:US
Mailing Address - Phone:513-686-4800
Mailing Address - Fax:
Practice Address - Street 1:4760 E GALBRAITH RD STE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6704
Practice Address - Country:US
Practice Address - Phone:513-686-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
OR2127103T00000X
OH7269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist