Provider Demographics
NPI:1538241732
Name:ANNETTE M. HERTZLIN-LOCKAMYEIR, LCSW PLLC
Entity type:Organization
Organization Name:ANNETTE M. HERTZLIN-LOCKAMYEIR, LCSW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERTZLIN-LOCKAMYEIR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:585-303-3724
Mailing Address - Street 1:117 DELAINA ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9344
Mailing Address - Country:US
Mailing Address - Phone:585-303-3724
Mailing Address - Fax:
Practice Address - Street 1:27 S PLATT ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1431
Practice Address - Country:US
Practice Address - Phone:585-303-3724
Practice Address - Fax:585-589-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069241-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02432180Medicaid
NY02432180Medicaid