Provider Demographics
NPI:1164262507
Name:LOCKLEAR, CLAUDETTE N
Entity type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:N
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-3408
Mailing Address - Country:US
Mailing Address - Phone:347-372-2166
Mailing Address - Fax:
Practice Address - Street 1:1280 CROTON LOOP APT 11A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1507
Practice Address - Country:US
Practice Address - Phone:347-331-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst