Provider Demographics
NPI:1649759796
Name:LACY, CHELSEA LOVE (LSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LOVE
Last Name:LACY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:BERNICE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:250 WORCESTER AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-4103
Mailing Address - Country:US
Mailing Address - Phone:717-649-3220
Mailing Address - Fax:
Practice Address - Street 1:5570 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3517
Practice Address - Country:US
Practice Address - Phone:717-412-0217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker