Provider Demographics
NPI:1962955757
Name:LACY, KIA
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NESHAMINY INTERPLEX DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 NESHAMINY INTERPLEX DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6944
Practice Address - Country:US
Practice Address - Phone:215-322-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst