Healthcare Provider Details

I. General information

NPI: 1093115107
Provider Name (Legal Business Name): LACI CHARETTE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BROAD ST
PLATTSBURGH NY
12901-2637
US

IV. Provider business mailing address

101 BROAD ST
PLATTSBURGH NY
12901-2637
US

V. Phone/Fax

Practice location:
  • Phone: 518-564-3385
  • Fax: 518-564-3397
Mailing address:
  • Phone: 518-564-3385
  • Fax: 518-564-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020755
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020755
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number020755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: