Provider Demographics
NPI:1124612650
Name:ALVAREZ, LACEY ROSE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:ROSE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:ROSE
Other - Last Name:CUKIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:82 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3888
Mailing Address - Country:US
Mailing Address - Phone:518-542-1667
Mailing Address - Fax:
Practice Address - Street 1:117 SUMMER ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2706
Practice Address - Country:US
Practice Address - Phone:781-747-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1216431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical