Provider Demographics
NPI:1255566386
Name:LACEY-HASTINGS, MONICA MAUREEN (LMSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MAUREEN
Last Name:LACEY-HASTINGS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:MAUREEN
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1660 STATE ROUTE 34B
Mailing Address - Street 2:
Mailing Address - City:KING FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:13081-8706
Mailing Address - Country:US
Mailing Address - Phone:315-364-5318
Mailing Address - Fax:
Practice Address - Street 1:146 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1831
Practice Address - Country:US
Practice Address - Phone:315-253-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0775801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical