Provider Demographics
NPI:1245067552
Name:LACONI, LANCE
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:LACONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 3RD AVE SW STE 203
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7596
Mailing Address - Country:US
Mailing Address - Phone:617-388-8637
Mailing Address - Fax:
Practice Address - Street 1:1089 3RD AVE SW STE 203
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7596
Practice Address - Country:US
Practice Address - Phone:617-388-8637
Practice Address - Fax:317-219-0747
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty