Provider Demographics
NPI:1245816370
Name:MORGAN-DEVELDER, LACY MARIE
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:MARIE
Last Name:MORGAN-DEVELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 WINTON RD S STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1637
Mailing Address - Country:US
Mailing Address - Phone:585-209-9773
Mailing Address - Fax:
Practice Address - Street 1:919 WINTON RD S STE 206
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1637
Practice Address - Country:US
Practice Address - Phone:585-209-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist