Provider Demographics
NPI:1336746916
Name:LACY, LISA M (PHD)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:LACY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MC INTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 OBRIEN DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1412
Mailing Address - Country:US
Mailing Address - Phone:650-600-8084
Mailing Address - Fax:
Practice Address - Street 1:1215 OBRIEN DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1412
Practice Address - Country:US
Practice Address - Phone:650-600-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician