Provider Demographics
NPI:1497799290
Name:PACE, BRUCE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:PACE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209
Mailing Address - Country:US
Mailing Address - Phone:716-249-4647
Mailing Address - Fax:716-463-2223
Practice Address - Street 1:1207 DELAWARE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209
Practice Address - Country:US
Practice Address - Phone:716-249-4647
Practice Address - Fax:716-463-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00015974103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527941001OtherCOMMUNITY BLUE
NY00030241503OtherUNIVERA