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NPI Code Detail

MEDICARE: MS. ELLIS MARIE RICH MACE PMHNP

MEDICARE: MS. ELLIS MARIE RICH MACE PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerRN2365088MA

General Provider Information

NPI Number : 1811338528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELLIS MARIE RICH MACE PMHNP
Provider Business Mailing Address
First Line : 82 WENDELL AVE STE 100
Second Line :
City : PITTSFIELD
State : MA
Zip : 01201-7066
Country : US
Telephone Number : 844-343-8002
Fax Number : 844-303-0338
Provider Business Practice Location Address
First Line : 82 WENDELL AVE STE 100
Second Line :
City : PITTSFIELD
State : MA
Zip : 01201-7066
Country : US
Telephone Number : 844-343-8002
Fax Number : 844-303-0338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2013
Last Update Date : 10/29/2024

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