Provider Demographics
NPI:1912072877
Name:PACEY, MARY LYRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYRA
Last Name:PACEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 EL DORADO
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-647-1480
Mailing Address - Fax:831-647-1480
Practice Address - Street 1:262 EL DORADO
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-647-1480
Practice Address - Fax:831-647-1480
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS6209104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37659ZMedicaid