Healthcare Provider Details

I. General information

NPI: 1093571796
Provider Name (Legal Business Name): CAMERYN ALEXANDRA LACEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S MAIN ST
CHESHIRE CT
06410-3153
US

IV. Provider business mailing address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

V. Phone/Fax

Practice location:
  • Phone: 203-272-1811
  • Fax: 203-271-3152
Mailing address:
  • Phone: 845-454-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number002282
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000605
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: