Provider Demographics
NPI:1134456429
Name:LACEY, DELORES L (MSW, LCSW, SAP)
Entity type:Individual
Prefix:MS
First Name:DELORES
Middle Name:L
Last Name:LACEY
Suffix:
Gender:F
Credentials:MSW, LCSW, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N HIGHWAY 67
Mailing Address - Street 2:#941
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033
Mailing Address - Country:US
Mailing Address - Phone:314-755-1952
Mailing Address - Fax:314-755-1951
Practice Address - Street 1:5494 BROWN ROAD
Practice Address - Street 2:SUITE 129
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1101
Practice Address - Country:US
Practice Address - Phone:314-755-1952
Practice Address - Fax:314-755-1951
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080008561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical