Provider Demographics
NPI:1487005278
Name:ALLEN, LACY (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12005 MANCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3526
Mailing Address - Country:US
Mailing Address - Phone:437-707-8319
Mailing Address - Fax:
Practice Address - Street 1:8005 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5753
Practice Address - Country:US
Practice Address - Phone:443-707-8319
Practice Address - Fax:443-558-3762
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500820861041C0700X
MD174071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical