Lacey Marie Wallace-Czirjak, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SC05313200 Issued in NJ

Practice address

15 West Prospect Street
East Brunswick, NJ 08816

Phone

(732) 254-0600

Fax

(732) 254-8606

NPI assigned

Jun 8, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Lacey M Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276560000000",
    "number": "1891015368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MASON AVE",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "08816",
            "telephone_number": "732-715-1877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 WEST PROSPECT STREET",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "08816",
            "telephone_number": "732-254-0600",
            "fax_number": "732-254-8606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-CZIRJAK",
        "first_name": "LACEY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-08",
        "last_updated": "2010-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SC05313200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LACEY",
            "last_name": "WALLACE",
            "middle_name": "M",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Howard K Waksman, MD
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• Patricia Wallace, LCSW
• David Michael Walor, MD
• Aihong Wang
• Stephen William Warren, MD
• William R Wasserstrom, MD

• All providers in East Brunswick, NJ
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.