Provider Demographics
NPI:1497111520
Name:SKWORTZ, LACEY (LCSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:SKWORTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:HEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1530 N 7TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1061
Mailing Address - Country:US
Mailing Address - Phone:260-424-9192
Mailing Address - Fax:260-426-0270
Practice Address - Street 1:1530 N 7TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1061
Practice Address - Country:US
Practice Address - Phone:260-424-9192
Practice Address - Fax:260-426-0270
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340067291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical