1134456429 NPI number — MS. DELORES L LACEY MSW, LCSW, SAP

Table of content: MS. DELORES L LACEY MSW, LCSW, SAP (NPI 1134456429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134456429 NPI number — MS. DELORES L LACEY MSW, LCSW, SAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LACEY
Provider First Name:
DELORES
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, SAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134456429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 N HIGHWAY 67
Provider Second Line Business Mailing Address:
#941
Provider Business Mailing Address City Name:
FLORISSANT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-755-1952
Provider Business Mailing Address Fax Number:
314-755-1951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5494 BROWN ROAD
Provider Second Line Business Practice Location Address:
SUITE 129
Provider Business Practice Location Address City Name:
HAZELWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63042-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-755-1952
Provider Business Practice Location Address Fax Number:
314-755-1951
Provider Enumeration Date:
11/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2008000856 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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