Provider Demographics
NPI:1811326325
Name:PONCINIE, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:PONCINIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SE FEDERAL HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4591
Mailing Address - Country:US
Mailing Address - Phone:772-678-6704
Mailing Address - Fax:
Practice Address - Street 1:2400 SE FEDERAL HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-678-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-14552103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst