Provider Demographics
NPI:1174864870
Name:LAC, KIM-MY LY (MSW)
Entity Type:Individual
Prefix:
First Name:KIM-MY
Middle Name:LY
Last Name:LAC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 CRUSHED PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2319
Mailing Address - Country:US
Mailing Address - Phone:352-359-6137
Mailing Address - Fax:
Practice Address - Street 1:11875 HIGH TECH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1400
Practice Address - Country:US
Practice Address - Phone:407-273-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW77671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical