Provider Demographics
NPI:1528585742
Name:SUCCES, NANCIE
Entity Type:Individual
Prefix:MS
First Name:NANCIE
Middle Name:
Last Name:SUCCES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12485 SW 137TH AVE #301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:305-846-9711
Mailing Address - Fax:305-846-9711
Practice Address - Street 1:10493 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5988
Practice Address - Country:US
Practice Address - Phone:561-275-4656
Practice Address - Fax:561-275-4656
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst