Provider Demographics
NPI:1194825182
Name:LACY, PETER C (LCSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:C
Last Name:LACY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CHURCH ST
Mailing Address - Street 2:CRAMER HOUSE
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1046
Mailing Address - Country:US
Mailing Address - Phone:518-584-9030
Mailing Address - Fax:518-581-1709
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:CRAMER HOUSE
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1046
Practice Address - Country:US
Practice Address - Phone:518-584-9030
Practice Address - Fax:518-581-1709
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069959-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical