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General NPI Number Information
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NPI Number | 1083486906
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Entity Type | Organization
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Legal Business Name | ANDREA MACE LICENSED EDUCATIONAL PSYCHOLOGIST
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 13 CLIFF WALK DR
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City | VALLEJO
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State | CA
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Zip | 94591-6432
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Country | US
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Telephone | 510-589-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 164 ROBLES WAY # 376
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City | VALLEJO
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State | CA
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Zip | 94591-8039
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA MACE
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Credential |
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Telephone | 510-589-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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