Provider Demographics
NPI:1003990987
Name:LACEY, MARGOT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARGOT
Other - Middle Name:GELLMAN
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:581 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2526
Mailing Address - Country:US
Mailing Address - Phone:914-941-2430
Mailing Address - Fax:
Practice Address - Street 1:160 N STATE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1403
Practice Address - Country:US
Practice Address - Phone:914-749-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0109999103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist