Provider Demographics
NPI:1609347509
Name:LACEY, ERICA (PHD, LCSW, LMFT)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:LACEY
Suffix:
Gender:
Credentials:PHD, LCSW, LMFT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-0120
Mailing Address - Country:US
Mailing Address - Phone:585-749-6429
Mailing Address - Fax:
Practice Address - Street 1:151 N 2ND ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1249
Practice Address - Country:US
Practice Address - Phone:315-944-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001797106H00000X
NY092541104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist