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NPI Code Detail

MEDICARE: MRS. BETHANY LACEY MSW

MEDICARE: MRS. BETHANY LACEY MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1952848830
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETHANY LACEY MSW
Provider Business Mailing Address
First Line : 3555 COMMONWEALTH BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32303-3119
Country : US
Telephone Number : 850-575-6422
Fax Number :
Provider Business Practice Location Address
First Line : 3555 COMMONWEALTH BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32303-3119
Country : US
Telephone Number : 850-575-6422
Fax Number : 850-575-7225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2017
Last Update Date : 01/30/2017

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Directions to “ MRS. BETHANY LACEY MSW” Practice Location

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