Provider Demographics
NPI:1770118184
Name:LACNY, LESLEY (MA)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:LACNY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 5TH ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3059
Mailing Address - Country:US
Mailing Address - Phone:503-805-9995
Mailing Address - Fax:
Practice Address - Street 1:450 5TH ST UNIT E
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3059
Practice Address - Country:US
Practice Address - Phone:503-805-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional