Healthcare Provider Details

I. General information

NPI: 1962771337
Provider Name (Legal Business Name): PATRICIA LACEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SECOND ST #1
HALLOWELL ME
04347-1331
US

IV. Provider business mailing address

116 SECOND ST #1
HALLOWELL ME
04347-1331
US

V. Phone/Fax

Practice location:
  • Phone: 207-446-2422
  • Fax: 207-622-6988
Mailing address:
  • Phone: 207-446-2422
  • Fax: 207-622-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC5081
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number# 075541
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1780C
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: