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General NPI Number Information
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NPI Number | 1053536847
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Entity Type | Individual
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Provider Name | ANGELIQUE LACOY COMMUNITY SERVICE
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 8 ATWOOD DRIVE
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City | NORTHAMPTON
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State | MA
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Zip | 01060-4266
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Country | US
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Telephone | 413-774-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 46 CONWAY STREET
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City | GREENFIELD
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State | MA
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Zip | 01301
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Country | US
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Telephone | 413-222-3958
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057002202
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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