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Individual

LACY CHAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
880 6TH ST S STE 420, ST PETERSBURG, FL 33701-4825
(727) 767-8477
Mailing address
880 6TH ST S STE 420, ST PETERSBURG, FL 33701-4825
(727) 767-8477
(727) 767-8244

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY8429
FL
103T00000X
Psychologist
Primary
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00355940
AGENCY MEDICAID PROVIDER ID
NY
01
1285628552
AGENCY NPI #
NY
01
WVE061
AGENCY MEDICARE ID#
NY
Enumeration date
08/18/2010
Last updated
11/16/2018
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