Provider Demographics
NPI:1902016462
Name:PACE, ROGER WINFRED I (MFT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:WINFRED
Last Name:PACE
Suffix:I
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:ROGER
Other - Middle Name:WINFRED
Other - Last Name:PACE
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:5964 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3105
Mailing Address - Country:US
Mailing Address - Phone:216-741-4456
Mailing Address - Fax:
Practice Address - Street 1:5964 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3105
Practice Address - Country:US
Practice Address - Phone:216-741-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM 0500002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist