Provider Demographics
NPI:1841507209
Name:LACY, LORI NICOLE (MA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:NICOLE
Last Name:LACY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:NICOLE
Other - Last Name:CALAMUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 E LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6238
Mailing Address - Country:US
Mailing Address - Phone:626-272-4214
Mailing Address - Fax:
Practice Address - Street 1:23461 S POINTE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1547
Practice Address - Country:US
Practice Address - Phone:949-855-1556
Practice Address - Fax:949-951-2871
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health