Provider Demographics
NPI:1023858016
Name:HABERSTROH, LACEY
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HABERSTROH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 SPRING ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3493
Mailing Address - Country:US
Mailing Address - Phone:603-266-9718
Mailing Address - Fax:
Practice Address - Street 1:16 TOWN CRIER DR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-8669
Practice Address - Country:US
Practice Address - Phone:802-689-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)