Provider Demographics
NPI:1134964489
Name:BRICE, PALEISA YARDLEY
Entity type:Individual
Prefix:
First Name:PALEISA
Middle Name:YARDLEY
Last Name:BRICE
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 1:37 MANOMET ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5020
Mailing Address - Country:US
Mailing Address - Phone:754-779-6752
Mailing Address - Fax:
Practice Address - Street 1:37 MANOMET ST APT 3
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5020
Practice Address - Country:US
Practice Address - Phone:754-779-6752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician