Provider Demographics
NPI:1992162705
Name:LOCKE, BREYANNA MARIE (MS, MA,LMFT)
Entity type:Individual
Prefix:MRS
First Name:BREYANNA
Middle Name:MARIE
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MS, MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 MIDSTATE LN
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9436
Mailing Address - Country:US
Mailing Address - Phone:607-426-0264
Mailing Address - Fax:
Practice Address - Street 1:8195 CAZENOVIA RD # 4
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9631
Practice Address - Country:US
Practice Address - Phone:607-426-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001259-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist