Basic Information
| Provider Information | |||||||||
| NPI: | 1699054502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACE | ||||||||
| FirstName: | F | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N PHILLIPS AVE APT 305 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571046047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073323412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 S UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333282018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542624100 | ||||||||
| FaxNumber: | 9542622271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2011 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | PY8302 | FL | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103K00000X | 1-09-5055 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.