Provider Demographics
NPI:1730221235
Name:LACEY, ROBIN FARBISZ (PHD)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:FARBISZ
Last Name:LACEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5973 N NORTHWEST HWY
Mailing Address - Street 2:3C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2651
Mailing Address - Country:US
Mailing Address - Phone:847-723-7438
Mailing Address - Fax:847-723-7599
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE 690
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-723-7438
Practice Address - Fax:847-723-7599
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical