Provider Demographics
NPI:1023786688
Name:BARROSO, LACEY (MSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:BARROSO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W MCKINLEY AVE STE 318
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-5651
Mailing Address - Country:US
Mailing Address - Phone:574-366-4616
Mailing Address - Fax:
Practice Address - Street 1:310 W MCKINLEY AVE STE 318
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-5651
Practice Address - Country:US
Practice Address - Phone:574-366-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011483A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical