Provider Demographics
NPI:1447341532
Name:LOCKE, GEOFFREY WALKER (LICSW)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:WALKER
Last Name:LOCKE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N PLEASANT ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1738
Mailing Address - Country:US
Mailing Address - Phone:413-253-8900
Mailing Address - Fax:
Practice Address - Street 1:48 N PLEASANT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1738
Practice Address - Country:US
Practice Address - Phone:413-253-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07767OtherBLUE CROSS BLUE SHIELD NU
MAP07767OtherBLUE CROSS BLUE SHIELD NU