=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225883234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRECIOUS LACEY LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2024
-----------------------------------------------------
Last Update Date | 04/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3505 PERRYSVILLE AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15214-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-476-1199
-----------------------------------------------------
Fax | 866-477-9988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3057 CENTRE AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15219-5030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-703-4218
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW141424
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------