Individual
DIANE LACKEY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
SW
Contact information
Practice address
1401 S 4TH ST, PHILA, PA 19147-5907
(215) 339-1079
Mailing address
432 N 6TH ST, PHILA, PA 19123-4004
(215) 925-2400
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW003075
PA
Other
Enumeration date
05/26/2006
Last updated
07/08/2007
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