Provider Demographics
NPI:1659825818
Name:GALE, LACEY ANDREWS (LCSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANDREWS
Last Name:GALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 FRONT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2657
Mailing Address - Country:US
Mailing Address - Phone:207-522-5335
Mailing Address - Fax:
Practice Address - Street 1:72 FRONT ST STE 1
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530
Practice Address - Country:US
Practice Address - Phone:207-522-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC161601041C0700X
MELC173291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical