Provider Demographics
NPI:1992792410
Name:LOCKTON, DEVORA (PHD)
Entity type:Individual
Prefix:DR
First Name:DEVORA
Middle Name:
Last Name:LOCKTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 BUTTERS RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1002
Mailing Address - Country:US
Mailing Address - Phone:760-729-6939
Mailing Address - Fax:760-729-6939
Practice Address - Street 1:1709 BUTTERS RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1002
Practice Address - Country:US
Practice Address - Phone:760-729-6939
Practice Address - Fax:760-729-6939
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10359103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP10359Medicare ID - Type Unspecified