Provider Demographics
NPI:1932428752
Name:DIAZ HABBEN, LACEY
Entity Type:Individual
Prefix:MS
First Name:LACEY
Middle Name:
Last Name:DIAZ HABBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:RODGERS SCHUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:ROCHDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01542-0125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 PINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1823
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program