Individual
DR. BRUCE LACKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
56 TAYLOR RD, ORONO, ME 04473-3205
(207) 866-0451
Mailing address
56 TAYLOR RD, ORONO, ME 04473-3205
(207) 866-0451
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CW 001208 L
PA
1041C0700X
Clinical Social Worker
Primary
LC10413
ME
1041C0700X
Clinical Social Worker
SC-02716
NJ
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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