Provider Demographics
NPI:1952848830
Name:LACEY, BETHANY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3119
Mailing Address - Country:US
Mailing Address - Phone:850-575-6422
Mailing Address - Fax:
Practice Address - Street 1:3555 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3119
Practice Address - Country:US
Practice Address - Phone:850-575-6422
Practice Address - Fax:850-575-7225
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker