| NPI | 1265995500 |
|---|---|
| Former Name | JAMIE LACEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20043290A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.010002) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2020-08-19 |