Provider Demographics
NPI:1508251034
Name:MARKS, LACEY M (LCSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:MARKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:M
Other - Last Name:BEACHEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-843-0314
Mailing Address - Fax:724-843-0316
Practice Address - Street 1:1302 7TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4217
Practice Address - Country:US
Practice Address - Phone:724-843-0314
Practice Address - Fax:724-843-0316
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130887104100000X
PACW0189501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030654040001Medicaid