Provider Demographics
NPI:1962771337
Name:LACEY, PATRICIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SECOND ST
Mailing Address - Street 2:#1
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1331
Mailing Address - Country:US
Mailing Address - Phone:207-446-2422
Mailing Address - Fax:207-622-6988
Practice Address - Street 1:116 SECOND ST
Practice Address - Street 2:#1
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1331
Practice Address - Country:US
Practice Address - Phone:207-446-2422
Practice Address - Fax:207-622-6988
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC50811041C0700X
NY# 0755411041C0700X
AL1780C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical