Most Relevant Information
Provider Data
| NPI Number: | 1003805557 |
| Provider Name: | MAURA LACEY BA |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/18/2005 |
| Last Updated: | 01/10/2008 |
Provider Practice Location
1955 US HIGHWAY 1 S
SUITE C-2
ST AUGUSTINE
FL
320863708
Practice Location Phone/Fax
| Phone: | 9042096037 |
| Fax: | 9042096002 |
Provider Mailing Location
1955 US HIGHWAY 1 S
SUITE C-2
ST AUGUSTINE
FL
320863708
Provider Mailing Phone/Fax
| Phone: | 9042096037 |
| Fax: | 9042096002 |