Provider Demographics
NPI:1144009358
Name:LACEY, JULIANA F (LPC)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:F
Last Name:LACEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PASCACK AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1067
Mailing Address - Country:US
Mailing Address - Phone:201-414-2407
Mailing Address - Fax:
Practice Address - Street 1:255 PASCACK AVE
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1067
Practice Address - Country:US
Practice Address - Phone:201-414-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00976500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist