Provider Demographics
NPI:1477097947
Name:LACEY FAMILY PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:LACEY FAMILY PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-800-7676
Mailing Address - Street 1:1333 LEE WAY
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4122
Mailing Address - Country:US
Mailing Address - Phone:732-800-7676
Mailing Address - Fax:732-700-7673
Practice Address - Street 1:3600 ROUTE 66 STE 150
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2645
Practice Address - Country:US
Practice Address - Phone:732-800-7676
Practice Address - Fax:732-800-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-18
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00560200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0541095Medicaid