Healthcare Provider Details

I. General information

NPI: 1144464124
Provider Name (Legal Business Name): PASQUA MARONGIU PSY D PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 MICHIGAN AVE BUILDING C-1
COCOA FL
32922-5758
US

IV. Provider business mailing address

1970 MICHIGAN AVE BUILDING C-1
COCOA FL
32922-5758
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-0063
  • Fax: 321-639-0064
Mailing address:
  • Phone: 321-639-0063
  • Fax: 321-639-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY7776
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPY7776
License Number StateFL

VIII. Authorized Official

Name: DR. PASQUA MARIA MARONGIU
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY D
Phone: 321-431-3222