Provider Demographics
NPI:1699100321
Name:KALB, LACEY NICOLE (MSED)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:NICOLE
Last Name:KALB
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PERTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3547
Mailing Address - Country:US
Mailing Address - Phone:914-260-5726
Mailing Address - Fax:
Practice Address - Street 1:41 PERTH AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3547
Practice Address - Country:US
Practice Address - Phone:914-260-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY769241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY769241OtherNEW YORK STATE CERTIFICATION