Provider Demographics
NPI:1710008743
Name:LACEY, DAVID P (PSYD-LMHC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:LACEY
Suffix:
Gender:M
Credentials:PSYD-LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3617
Mailing Address - Country:US
Mailing Address - Phone:401-789-1367
Mailing Address - Fax:401-789-6744
Practice Address - Street 1:4705A OLD POST RD
Practice Address - Street 2:SOUTH SHORE MENTAL HEALTH CENTER
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-1819
Practice Address - Country:US
Practice Address - Phone:401-363-7705
Practice Address - Fax:401-364-9104
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDL57324Medicaid
RI1710008743OtherBLUE CROSS BLUE SHIELD OF RHODE ISLAND
RI374867OtherMHN