Provider Demographics
NPI:1063721710
Name:LANSING, KACY J (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KACY
Middle Name:J
Last Name:LANSING
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 DIXWELL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3195
Mailing Address - Country:US
Mailing Address - Phone:203-213-7125
Mailing Address - Fax:
Practice Address - Street 1:2911 DIXWELL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3195
Practice Address - Country:US
Practice Address - Phone:203-213-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2495101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid