Healthcare Provider Details

I. General information

NPI: 1053536847
Provider Name (Legal Business Name): ANGELIQUE LACOY COMMUNITY SERVICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ATWOOD DRIVE
NORTHAMPTON MA
01060-4266
US

IV. Provider business mailing address

46 CONWAY STREET
GREENFIELD MA
01301
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-1000
  • Fax:
Mailing address:
  • Phone: 413-222-3958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057002202
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: